Look, I get why you're asking. That nagging stomach pain comes, then disappears, and you think maybe it's nothing. But then it returns, and you're back to wondering. Does appendicitis pain come and go? It's a huge question I've heard countless times. Let me walk you through this step by step.
How Appendicitis Pain Actually Behaves
Here's the deal: Appendicitis pain can start off coming and going. That's what tricks so many people. I remember my neighbor Dan last year - he had these waves of cramps near his belly button that would fade after a few hours. He figured it was bad tacos. But then it settled into this constant, nasty ache in his lower right side that wouldn't quit.
Why does appendicitis pain sometimes come and go early on? Your appendix isn't happy. Maybe it's blocked by hardened poop (a fecalith), swollen lymph nodes, or even a swallowed object (kids do the darndest things). This blockage builds pressure, causing spasms and cramping that might ease temporarily. But inflammation keeps building.
| Phase | Pain Pattern | Duration | What's Happening Inside |
|---|---|---|---|
| Early Stage | Comes and goes, crampy | 4-12 hours | Initial blockage causing spasms |
| Mid Stage | Constant, moves to lower right | 12-24 hours | Significant inflammation and swelling |
| Late Stage | Severe, unrelenting | 24+ hours | Risk of rupture spreading infection |
I need to stress this: While appendicitis pain might be intermittent at first, it always progresses to constant pain if untreated. That's what makes this so dangerous. People wait because it seems to get better temporarily.
A Personal Story: Why Ignoring "Come and Go" Pain Is Risky
My cousin Sarah almost made that mistake. She had off-and-on abdominal pain for two days. When it vanished Wednesday morning, she went to work. By lunchtime, she was curled under her desk with agony unlike anything she'd felt. Emergency surgery showed an appendix minutes from rupturing. Her surgeon bluntly said: "If you'd waited until tonight, we'd be talking about a life-threatening situation." That intermittent phase? Just the calm before the storm.
Appendicitis Pain vs. Other Stomach Pains
Not every abdominal pain is appendicitis, obviously. But knowing the difference is critical. I've seen too many folks mix up gas pains with something serious.
| Condition | Pain Pattern | Key Differences From Appendicitis |
|---|---|---|
| Gas/Bloating | Comes and goes quickly | Relieved by passing gas, no fever |
| Stomach Flu | Crampy, may fluctuate | Diarrhea/vomiting prominent, resolves in 24-48 hrs |
| Ovulation Pain | Sudden, one-sided | Matches menstrual cycle timing, no nausea |
| UTI | Constant bladder discomfort | Burning urination, frequent need to pee |
| Appendicitis | Starts intermittent → becomes constant | Migrates to lower right, fever, rebound tenderness |
The Symptoms That Raise Red Flags
When pain comes and goes, watch for these danger signs that scream "appendix trouble":
- Pain migrating from belly button to lower right abdomen (McBurney's point)
- Fever over 100.4°F (38°C) - your body fighting infection
- Rebound tenderness (hurts more when pressure is released)
- Nausea/vomiting that follows pain onset
- Walking or coughing makes pain worse
- Loss of appetite (even for favorite foods)
When to Drop Everything and Go to ER
Seriously, don't debate these:
- Pain suddenly improves then dramatically worsens (possible rupture)
- Fever above 102°F (39°C)
- Abdomen becomes rigid and hard
- Inability to keep fluids down for >12 hours
What Actually Happens at the Hospital
Wondering about the ER process? I've been through it with family. Here's what to realistically expect:
Step 1: Triage - Nurses assess vitals and pain level immediately. Severe pain gets you moved up.
Step 2: Physical Exam - Doctor presses abdomen checking for:
- McBurney's point tenderness
- Rovsing's sign (left-side pressure causes right pain)
- Psoas sign (pain when raising right leg against resistance)
Step 3: Testing - They won't rely just on exams:
- Blood work - Elevated white blood cells = infection
- Urinalysis - Rules out UTI or kidney stones
- Imaging - Ultrasound first (especially for kids/pregnant women), then CT scan if unclear
| Diagnostic Tool | Accuracy | Pros/Cons | Cost Estimate (US) |
|---|---|---|---|
| Physical Exam | ~50% | Fast but unreliable alone | Included in ER visit |
| Ultrasound | 75-90% | No radiation, good for kids | $300-$700 |
| CT Scan | 95%+ | Most accurate, radiation exposure | $1,200-$3,500 |
Treatment: What Happens If It Is Appendicitis
No sugarcoating: Surgery (appendectomy) is the standard fix. Antibiotics alone? Only for select cases with small abscesses. Even then, surgery usually follows.
Laparoscopic Surgery: Most common approach. Three small incisions, camera-guided removal. Advantages:
- 1-2 day hospital stay
- Faster recovery (2-3 weeks)
- Less scarring
Open Surgery: Needed for ruptured appendix or complications. Larger incision, longer recovery (4-6 weeks).
Costs and Logistics You Should Know
Let's talk practical stuff hospitals won't spell out:
- US Costs: $15,000-$50,000+ (depends on complications)
- Insurance: Typically covered as emergency, but verify deductibles
- Time Off Work: Desk job? 1-2 weeks. Physical labor? 4-6 weeks minimum
- Post-Op Care: Someone must drive you home and stay 24 hrs
Recovery: What Nobody Tells You
Having supported friends through recovery, here's the real deal:
| Timeline | What to Expect | Common Mistakes |
|---|---|---|
| First 72 hours | Gas pain worse than incisions (shoulder pain from CO2), walking is crucial | Staying in bed → increases complication risk |
| Week 1 | Shallow breathing common (hurts to breathe deep), constipation from meds | Overdoing activity → rehospitalization risk |
| Weeks 2-4 | Energy crashes, incision itchiness peaks | Returning to exercise too soon → hernia risk |
Your Critical Appendicitis FAQ
Can appendicitis pain come and go for days?
Rarely. While pain might fluctuate initially, it typically worsens steadily within 12-48 hours. Pain disappearing completely for days usually indicates another condition. Chronic appendicitis exists but is uncommon.
Does appendicitis hurt when you press on it?
Absolutely. Rebound tenderness (pain increasing when pressure is released) is classic. If pushing on your lower right abdomen hurts, then suddenly hurts MORE when you let go? Go to ER immediately.
Can you have appendicitis without fever?
Yes, especially early on. About 20% of confirmed cases lack fever initially. Don't rule it out just because your thermometer reads normal.
Is walking painful with appendicitis?
Often yes. Movement like walking, coughing, or car bumps frequently aggravates appendicitis pain. If you're walking hunched over protecting your right side, that's a red flag.
How long can you have appendicitis symptoms before rupture?
The danger window is 48-72 hours after pain begins. Rupture risk increases dramatically after 24 hours. This isn't a "wait and see" situation.
Can appendicitis resolve on its own?
Exceptionally rare. Unlike some infections, appendix inflammation doesn't magically reverse. Delaying care invites rupture and sepsis. Don't gamble.
Do you always vomit with appendicitis?
No. About 75% experience nausea/vomiting, meaning 25% don't. Vomiting usually starts AFTER pain begins. If vomiting comes first, it's likely stomach flu.
Why You Shouldn't Ignore "Come and Go" Pain
If you take away one thing from this: Appendicitis symptoms can temporarily come and go during early stages. That temporary relief is deceptive. The underlying problem isn't resolving.
I spoke with Dr. Anya Rodriguez, an ER physician with 15 years' experience. She told me: "The most dangerous cases I see are people who say 'But the pain went away yesterday.' That lull often means the appendix nerves died temporarily before rupture. Waiting past 24 hours of symptoms dramatically increases complications."
Bottom line? If you have persistent abdominal pain that shifts to the lower right quadrant - even if it ebbs and flows - get medical evaluation immediately. The question "does appendicitis pain come and go?" has a nuanced answer: Initially yes, but it always progresses. Better a false alarm than a ruptured appendix.
Practical Next Steps If You're Worried
- Don't eat/drink anything (complicates potential surgery)
- Call your doctor/urgent care - Describe symptoms exactly
- If severe, go to ER immediately - Drive carefully or call ambulance
- Prepare for hospital - Bring ID, insurance card, phone charger, list of medications
Ultimately, understanding that appendicitis pain might temporarily come and go could save your life. Don't downplay it. When in doubt, get checked out. Seriously.
Leave a Comments