Appendix Pain (Location) and Surgical Removal (Appendectomy)

Where Is Appendix Located?

Appendix is usually located in the right lower abdomen, between the navel and the upper part of the pelvic bone (Picture 1). The exact location differs from person to person, but is usually at or few inches around the McBurney’s point – two thirds of distance between the navel and upper part of the pelvis (Picture 1). Rarely, appendix is located on the opposite (left) side of the abdomen.

Appendix location

Picture 1: Appendix location: under the red spot,
or few inches away (in any direction)

Appendix location

Picture 2: Appendix is located on the beginning of the large intestine

Appendix Pain Causes

Acute appendicitis is the main cause of acute appendix pain. Appendix rupture may follow if treatment is delayed. Chronic appendicitis is also possible.

Symptoms and Signs of Acute Appendicitis

The following symptoms are usually present in acute appendicitis:

  • Sudden pain around the navel that moves to the lower right abdomen in next hours.
    • The painful spot is tender to touch and abdominal wall above the appendix is rigid.
    • Pressure put (by hand) on the leftside of the abdomen and quickly released, triggers pain above the appendix (rebound tenderness, Rovsing sign).
    • Pain worsens with coughing or moving around, or when you drop from standing on toes to heels quickly. Pain is often relieved by lying on the back with legs bent in the knees.
    • Rarely — if the appendix is long or located on the right side (situs inversus) — pain can be felt in the lower left abdomen.
  • Loss of appetite, nausea and vomiting occuring after the onset of pain. Vomiting before onset of pain speaks for bowel obstruction.
  • Diarrhea or constipation may sometimes occur.
  • Urinary symptoms, like urgency to empty the bladder, may appear.
  • Low grade fever may be present.

High fever and rapid breathing may speak for appendix rupture. Usually only surgery reveals, if the appendix is ruptured or not.

Symptoms of Chronic Appendicitis

In chronic appendicitis, symptoms may slowly develop during several weeks.

In practise, diagnosis of appendicitis is not always easy, since there are several other possible causes of a right lower abdominal quadrant (RLQ) painarising from the abdominal wall (injury), skin (shingles), colon (constipation, Crohn’s disease), small intestine (hernia, adhesions), ovaries (twisted ovary), Fallopian tubes (ectopic pregnancy, pelvic inflammatory disease), ureter (urinary stones), bladder (infection), or testicles (torsion).

Diagnosis of Appendicitis

Inflamed appendix can be detected by CT or ultrasound in most cases. Blood test shows elevated white blood cells and C-reactive protein (CRP). Other causes of lower right abdominal pain should be considered.

Appendectomy (Appendicectomy)

Appendectomy, or appendicectomy, is the surgical removal of the appendix, which is a small, long sac attached to the first part of the large intestine. Appendicitis is the inflammation of the appendix and untreated acute appendicitis may lead to rupture of the appendix. Acute appendicitis is the most common surgical emergency and though mild cases may be treated with antibiotics, appendectomy is the treatment of choice.

Types of Appendectomy

There are two surgical techniques for appendectomy.

  1. Open appendectomy
  2. Laparoscopic appendectomy

Both operations are performed under general anesthesia.

Open Appendectomy

A small incision, about two to three inches, is made in the skin over the appendix location on the right side of the abdomen. The appendix is reached by cutting through the layers of the abdomen (skin, connective tissue and muscle) and then removed.

Laparoscopic appendectomy

This is a minimally invasive surgical technique where three or four tiny cuts are made in the abdomen through which a laparoscope, with a miniature camera and surgical instruments, are inserted into the abdominal cavity to remove the appendix.

Advantages of Laparoscopic Appendectomy

Laparoscopic appendectomy is often the preferred choice for the following reasons

  1. Quick healing time with smaller scar.
  2. Less post-operative pain and complications.
  3. Shorter hospital stay, since patients are discharged within 24 to 36 hours as compared to 2 to 5 days in the open method.

Contradictions for Laparoscopic Appendectomy

A laparascopic appendectomy may not be considered in the following pre-existing conditions due to the high risk of complications.

  • Heart disease
  • Chronic obstructive pulmonary disease
  • Obesity
  • Previous abdominal surgery


About Jan Modric (249 Articles)
Health writer

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  • Hilda

    I woke up last night with a very sharp pain on my right side. It didn’t last long. I thougt it could be my appendix and this morning found out its located on the right side.
    Since the pain has not yet come back, must i still see a doctor? Am i worrying for nothing?

    • Jan Modric


      pain from appendicitis does not likely just disappear. A sudden sharp pan may be caused by an urinary stone temporarily stuck in the right ureter, for example. If the pain or any other symptom, like blood in the urine or stool, fever or anything abnormal, appears again, I recommend you to see a doctor.

  • bulu

    yesterday night I felt pain at the particular location of appendix I felt that a finger like push in side and it continue to perhaps first 6 hour more then 10 hour slow pain now i feel much better no other symptoms may i consult the doctor
    or not……..

    • Dr. Chris

      Hi Bulu

      Yes, you should see a doctor. Even if it is not appendicitis, it may be some other equally serious disorder. Pain on its own is non-specific but if it starts up and lasts for so long for no known reason then it must be investigated. This may be the first symptom of some underlying disease process. It could also be muscular in origin – abdominal muscle strain is common but only your doctor can verify this.

  • gary

    Appendix pain area which is aching for about 2 minutes at a time and longer on some occasions. Sometimes it is a sharp pain Pain has been going on and off for eight hours, slowly getting worse and lasting longer. I do already have fibro-myalgia, ulcerative colitis and arthritis. Is this pain a result of fibro or could it be something else?

  • Rachel

    I feel pain on my lower right side near to my hip do you think it may be the appendix . Should i go to the doctor

  • Sarah

    I’ve been having a lot of pain in my rite lower abdomon area below my belly button, it just keeps gettin worse. I can barley stand up straight, let alone stand up. Could that be my appendix? What should I do? Its hurting me so bad! Please help, thanks Sarah.

    • Hi Sarah. Yes, it could be your appendix given the location and severity of the pain. But also take notice of other typical appendix symptoms. If it is indeed appendicitis then you could be risking your life by not seeking medical attention immediately. Also remember that ovarian and fallopian tube problems can be a cause for pain so low down and to the right, as well as issues with your colon or other abdominal and pelvic organs. Pain on its own is difficult to diagnose without diagnostic investigation so you doctor may have to do an ultrasound scan or other tests. See your doctor ASAP.

  • Muhammad Irfan

    I was facing pain in my right side of abdominal, there is no other symptoms that u have mentioned, no fever no Diarrhea non others, i had take treatment to Doctor, pain is gone but i still feel something heavy in same area, blood report is ok white cells are normal. what i have to do and is there any appendix?

  • Alexis

    I’ve been having pain in my lower left side and I’m constipated . Plus I’ve had to go pee alot. And if i touch my lower left side it hurts. I’ve only had this feeling for about a week now. Should I get it checked out? Any clue what it could be?

    • Hi Alexis. It’s unlikely to be the appendix because in most people that is located on the lower right side. However, the pain may be throughout the abdomen and just more intense on the lower right in appendicitis. Given your frequent urination this could very well be a urinary tract infection (UTI) or some other urinary problem. The results of a quick home urine dipstick test could help indicate what may be the problem but seeing a doctor is the better option. Yes, you should have it checked up if you have not one so already.

  • Julie

    Just had my appendix removed laparoscopic surgery, I had very high blood pressure(hypertension) out of hospital 24 hours after. Having issues with nausea and tingling all over, usually after eating something. would this be related to op or blood pressure?

    • HI Julie. It really is difficult to say for sure. High blood pressure can cause a range of symptoms but the fact that it starts after eating more likely points to a digestive condition which could be related to the appendix removal. The strong painkillers you are using may also be an issue. It is advisable that you follow up with the surgeon. Hopefully you are monitoring your blood pressure at home so take note if the symptoms also correlate with any rise in the blood pressure.

  • lizzi

    I woke up this morning and just below my belly button hurt and the pain has moved to the lower right and it is severe. It hurts to stand, cough, move, whatever. I just wanna curl up in a ball and cry. I am also running a low grade fever, chills, nausea, vomiting and fatigue. Thinks its my appendics or something else? Ive had 3 prior surgeries. 2 for ovarian cysts and one for gallbladder removal.