Back Pain

Appendicitis can cause back pain in some cases. Depending on the location of the appendix, the pain may radiate to the lower part of the right back. In the course of the disease, the pain may also move from the upper abdomen to the lower back.

Can one have appendicitis without pain?

An appendicitis can also be without or only mild pain. It may be that the affected person only feels a slight pulling in the lower abdomen or pain only occurs when pressure is applied to the abdomen. This is especially the case with older people.

However, appendicitis usually begins with pain in the middle upper abdomen slightly above the navel, which then moves to the right lower abdomen. The pain can be felt to varying degrees depending on the person. Diarrhoea (diarrhoea) is a typical symptom of a variety of gastrointestinal diseases.

One speaks of diarrhoea if watery, unformed or mushy stools occur more often than three times a day. The most common cause of diarrhoea is viruses (e.g. “gastro-enteritis” or travel diarrhoea). Medicines, food or certain diseases such as chronic inflammatory bowel disease can also cause diarrhoea.

Diarrhoea can also be caused by acute appendicitis. In contrast to the other causes of diarrhoea, typical symptoms of appendicitis often occur simultaneously. Pain, which first appears in the umbilical region and within a short time migrates to the right lower abdomen, as well as nausea and vomiting, fever, loss of appetite and a worsening of the general condition can, in connection with diarrhoea, speak for an acute appendicitis. Diarrhoea is not a classic symptom of appendicitis, but since the disease often presents with untypical symptoms, appendicitis should be considered even in the case of acute diarrhoea.

Diagnosis

A typical or “classic” combination of symptoms is very rare in appendicitis. Often there are diffuse symptoms that do not allow a clear diagnosis at first. For the diagnosis of appendicitis, the patient’s medical history (anamnesis) is an important criterion.

Typically, the medical history is relatively short, with short periods of abdominal pain, nausea and vomiting. Since appendicitis is a relatively common disease, it is considered a diagnosis as soon as a few but typical symptoms occur. A physical examination is then carried out.

This can quickly substantiate the suspicion of appendicitis, as there are a number of tests and examinations that indicate the disease. If the physical examination shows no abnormalities, appendicitis can be ruled out with a high degree of probability. In addition, a laboratory examination is carried out for the diagnosis.

In the case of appendicitis, for example, an increase in white blood cells (leukocytosis) is almost always detectable. The body temperature is measured and, if possible, an ultrasound examination (sonography) is carried out. Sonography often reveals a thickened appendix, which could indicate appendicitis.

However, even with an inconspicuous ultrasound examination, acute appendicitis cannot be ruled out one hundred percent. On the contrary, the sonography serves to exclude other diseases that can cause similar symptoms to appendicitis, such as kidney stones and other diseases of the kidney and ureter as well as gynaecological diseases. The most common alternative diagnosis is a so-called “gastroenteritis” (gastroenteritis).

However, various other diseases must also be ruled out before “appendicitis” is diagnosed, especially before the indication for surgery is given. In particularly severe cases, an MRI of the abdomen may also be necessary. Ultrasound of the abdomenThere are a number of possible tests that can confirm the suspicion of appendicitis.

A clear diagnosis cannot be made by these tests and in some cases even a negative test does not rule out appendicitis. A simple test, for example, is hopping on one leg. In the case of appendicitis, the jumping may increase the pain in the abdomen due to the vibration caused by the hopping.

There are also a number of different pressure points that are palpated during the clinical examination of the abdomen. For example, palpation of certain parts of the lower abdomen (Mc-Burney point, Lanz point) can often cause severe pain in appendicitis. In most cases appendicitis is located on the right side.

In the so-called Blumberg test, pressure is applied to the lower abdomen on the left side with the examiner’s hand and suddenly released. The test is positive and may indicate appendicitis if pain develops on the right side of the appendix. In some people, the appendix is also folded back.

Here, in the case of inflammation, pain occurs when the right leg is bent against resistance in the hip joint. This test (so-called psoas-stretching pain) can also provide indications of appendicitis. The Ten-Horn test can be performed in men by actively pulling down the testicles.

If this causes pain in the right lower abdomen (Mc-Burney point), the test is positive. The age-appendicitis is with 5-10% rather less frequent and is characterized by a creeping course. Due to the frequent rate of progression, peritonitis is also particularly common in this group of patients. Appendicitis during pregnancy is particularly difficult to diagnose because the appendix and appendix appendix move upwards as the uterus grows. This means that, depending on the month of pregnancy, the appendix may be located in an atypical place (right upper abdomen), which can lead to false diagnoses.