Is It Appendicitis Or Cramps?

Medically reviewed by: Liza M. Capiendo, MD

Appendicitis occurs when the appendix — a part of the large intestine — becomes inflamed. And for the most part, it can feel very similar to abdominal and menstrual cramps.

But, unlike cramps that come and go, inflammation of the appendix is a medical emergency and requires prompt care.

Therefore, knowing how to differentiate between them is absolutely vital.

In this article, we’ll discuss how the symptoms of appendicitis are different from cramps, and how appendicitis is diagnosed and treated.

What are the symptoms of appendicitis?

The most common symptom of appendicitis is a sudden, aching, or sharp pain that originates near the belly button before migrating to the right lower side of your abdomen.

It may feel like an abdominal cramp at first and often worsens when you move, cough, or inhale deeply.

In addition to abdominal pain, patients with appendicitis may also experience:

  • Nausea and vomiting
  • Loss of appetite
  • Fever
  • Abdominal bloating
  • Diarrhea or constipation
  • Increased urinary urgency and frequency
  • Pain when extending the right hip or leg

The early signs of appendicitis are often subtle and usually appear within the first 12-24 hours of the inflammation.

How can you tell if your child has appendicitis?

Most cases of appendicitis occur in people between 10 and 20 years of age. So it’s important to be familiar with how appendicitis shows up in children. This is because younger children are not able to properly describe their symptoms, which can cause delay in seeking treatment.

Other than complaining of stomach pain, a child with appendicitis may show physical signs of pain, such as:

  • Bending over at the waist when walking
  • Acting silent and withdrawn
  • Being extra fussy and agitated
  • Lying on their sides with their knees bent and drawn upward
  • Pain upon touching the abdomen
  • Nausea and vomiting

What are the symptoms of appendicitis in pregnant women?

Although uncommon, appendicitis can also occur during pregnancy. For the most part, the symptoms of appendicitis in pregnant women are similar to those in non-pregnant patients.

However, due to the growing baby, the position of the appendix in pregnant women is often higher in the abdomen. This is why the pain of appendicitis is felt higher up in the right side of the abdomen of pregnant women.

Failure to get medical attention on time can result in a ruptured appendix, which can be life-threatening for both the mother and the baby.

Now that you understand how appendicitis shows up, let’s discuss the symptoms of abdominal and menstrual cramps, and how they’re different from appendicitis.

What are the symptoms of abdominal cramps?

Abdominal cramps can feel like there are knots in your stomach or that there is gas moving through your gut.

Unlike appendicitis — which often causes constant localized pain near the lower right side of your abdomen — pain from stomach cramps can occur anywhere in your belly. It can even be felt up in your chest.

Also, the discomfort caused by abdominal cramps is often temporary (lasting only a few minutes to hours) and usually comes and goes on its own.

If you feel better after passing gas or burping, then you probably had typical gas pain. Other common causes of stomach cramps include:

  • Indigestion
  • Constipation
  • Diarrhea
  • Food poisoning

However, if the pain is constant and lasts longer than a few hours, then it may be a sign of something more serious.

What are the symptoms of menstrual cramps?

Menstrual cramps are aching, throbbing cramps that some women experience in their lower bellies just before and during their periods. The pain from menstrual cramps may range from moderate to severe and can sometimes be mistaken for appendicitis pain.

However, unlike appendicitis, pain due to menstruation has a different presentation that includes:

  • Cramping or throbbing pain in your lower abdomen
  • Pain that begins regularly 1-3 days before your period, peaks at 24 hours after onset, and goes away in 2-3 days
  • Radiation of the pain to the thighs and lower back

What are some other causes of abdominal pain?

Apart from the conditions discussed above, some other common causes of abdominal pain include:

  • Gallstones
  • Peptic ulcers
  • Bacterial or viral gastroenteritis
  • Irritable bowel syndrome (IBS)
  • Crohn’s disease
  • Lactose intolerance
  • Food allergies
  • Stomach flu
  • Ovarian cysts
  • Ectopic pregnancy
  • Diverticulitis 
  • Pelvic inflammatory diseases (PIDs)
  • Hernia
  • Urinary tract infections (UTIs)
  • Kidney infections
  • Kidney stones

It’s important to realize that the level of discomfort and pain doesn’t always correlate to the severity of the condition causing the symptoms.

Serious conditions like colon and stomach cancer may only cause moderate pain, while an inconsequential bout of gas may result in considerably painful cramps.

This is one reason why it’s important to undergo regular colon cancer surveillance after 50 years of age. If you have risk factors for cancer, you may need a colonoscopy before 50 years.

Carefully assessing the specific type of pain you’re having can help you better narrow down on the condition you may have. And for that, it’s important not to delay seeking medical attention.

When should you seek medical attention?

If you’re suffering from unexplained abdominal pain that comes suddenly and is situated in the lower right area of your abdomen, you should determine whether you also have other symptoms such as nausea, vomiting, and fever.

If you have any of these symptoms and the pain gets worse, seek emergency medical care immediately.

Untreated appendicitis can lead to life-threatening complications like sepsis, where there is a generalized inflammatory reaction in the body that causes multi-organ failure.

How is appendicitis diagnosed?

The diagnosis of appendicitis is usually apparent after taking a history and performing a physical exam. Sometimes, investigations like blood tests and imaging might also be required.

After asking you questions about the onset, severity, and duration of your pain, your doctor will perform a physical exam on you.

This involves pressing gently on the painful area. If the pain worsens when the doctor presses down on the area, this could indicate that the appendix is inflamed.

Another sign — known as “guarding” — may also hint that your body is trying to cushion an inflamed appendix.

Guarding is the tightening of abdominal muscles when anticipating pressure on a painful area and is a characteristic finding in patients with appendicitis.

Finally, doctors may also use various lab tests and diagnostic tools to confirm the diagnosis. These include:

  • Blood tests: Although these tests can’t specifically check for appendicitis, they can help rule out other potential causes of your symptoms such as infections, fluid or electrolyte imbalances, and dehydration.
  • Ultrasound, X-ray, and CT scan: These imaging tests can be used to determine whether your appendix is inflamed. They can also be used to uncover other potential causes of your pain.
  • Urine tests: These tests can help rule out urinary tract infections and kidney stones, which are a common cause of abdominal pain.
  • Pregnancy test: This test lets doctors rule out ectopic pregnancy, which is very similar to appendicitis in terms of symptoms.

How is appendicitis treated?

In most cases, the treatment of appendicitis involves an appendectomy, which is the surgical removal of the appendix.

Surgeons can perform an appendectomy using one of the two methods outlined below. Antibiotics are used with both types of procedures to treat any remaining infection.

Open surgery

An open appendectomy involves one large incision in the lower right quadrant of the abdomen.

This type of surgery is often needed when your appendix has ruptured and its surroundings need to be treated for infection.

Laparoscopic surgery

In laparoscopic colon surgery, surgeons create multiple small openings to insert special surgical tools and a narrow tube with a light and camera.

This type of appendix surgery involves fewer risks, lesser discomfort, faster recovery time, and lesser scarring than open surgery.