If you have appendicitis and it’s not treated, your appendix can rupture. When this happens, bacteria are released into your abdomen and cause a serious infection. This can make you very sick and be hard to treat.

Your appendix is a small, thin, wormlike sac. It’s located where your small and large intestines connect in your lower abdomen on the right side. Most doctors think it doesn’t have an important function and can be removed without causing negative effects.

Appendicitis can happen at any age, but it occurs most often in children and teenagers between the ages of 10 and 20. It’s more common in males.

A study in the Journal of the American College of Surgeons found the risk of rupture was less than 2 percent when appendicitis was treated within 36 hours of the start of symptoms. It increased to 5 percent when it was treated 36 hours or more after the start of symptoms.

The exact cause of appendicitis isn’t known for sure, but doctors think it’s probably due to an infection that triggers inflammation inside of it.

There are normally a lot of bacteria in your intestine. When the opening of the appendix gets blocked, bacteria get trapped inside and reproduce quickly, causing an infection.

When appendicitis isn’t treated promptly and appropriately, bacteria and pus made in reaction to the infection build up. As this happens, pressure builds and the appendix swells. Eventually, it swells so much that the blood supply to part of the appendix gets cut off. That part of the wall then dies.

A hole or tear develops in the dead wall. The high pressure pushes the bacteria and pus into the abdominal cavity. So, a ruptured appendix usually oozes or leaks into the abdomen, rather than bursting like a balloon.

The symptoms of appendicitis can be similar to those of other conditions that affect the abdomen, such a stomach flu or ovarian cyst. For this reason, it can be hard to tell if you have appendicitis.

If you have these symptoms and think you have appendicitis, get evaluated by a doctor as soon as possible. Prompt treatment is essential to avoid rupture. Rupture can occur within 36 hours of the onset of symptoms.

The classic symptoms of appendicitis are pain starting around the belly button followed by vomiting. Several hours later, the pain moves to the lower abdomen on the right side.

One study found only about half of the people who get appendicitis have these classic symptoms.

Other symptoms of appendicitis include:

  • fever
  • nausea and vomiting
  • abdominal pain that may start in the upper or middle abdomen but usually settles in the lower abdomen on the right side
  • abdominal pain that increases with walking, standing, jumping, coughing, or sneezing
  • decreased appetite
  • constipation or diarrhea
  • inability to pass gas
  • bloated or swollen abdomen
  • abdominal tenderness when you push on it that may worsen when you quickly stop pressing on it

The pain is often spread out all over the abdomen in babies and children. In pregnant and older people, the abdomen may be less tender and pain may be less severe.

Once your appendix ruptures, symptoms vary depending on what happens. At first, you may actually feel better for a few hours because the high pressure in your appendix is gone along with your original symptoms.

When bacteria leave the intestine and enter the abdominal cavity, the lining on the inside of your abdomen and outside of abdominal organs become inflamed. This condition is called peritonitis. It’s a very serious condition that can be very painful and requires immediate treatment. The symptoms will be similar to those for appendicitis, except:

  • the pain is in your entire abdomen
  • the pain is constant and more severe
  • fever is often higher
  • your breathing and heart rate may be fast in response to the severe pain
  • you may have other symptoms including chills, weakness, and confusion

When there’s an infection in your abdomen, the surrounding tissues sometimes try to wall it off from the rest of the abdominal cavity. When this is successful, it forms an abscess. This is a closed off collection of bacteria and pus. Symptoms of an abscess are also similar to those for appendicitis, except:

  • the pain may be in one area, but not necessarily the lower right abdomen, or it may be in your entire abdomen
  • the pain can be either a dull ache or sharp and stabbing
  • fever is usually persistent, even when you take antibiotics
  • you may have other symptoms, like chills and weakness

When left untreated, the bacteria from a ruptured appendix can get into your bloodstream, causing a serious condition called sepsis. This is inflammation that occurs throughout your entire body. Some of the symptoms of sepsis are:

  • fever or a low temperature
  • fast heartbeat and breathing
  • chills
  • weakness
  • confusion
  • low blood pressure

The treatment for a ruptured appendix is removal of your appendix through surgery. Peritonitis is treated by cleaning the abdominal cavity during surgery to remove bacteria. You’ll usually receive antibiotics through a vein, at least for the first few days. You may need to use antibiotics for several weeks to be sure the infection is gone.

Often, your appendix will be removed immediately. If there’s a large abscess, your doctor might want to drain it before surgery. This is done by inserting a tube into the abscess and letting the fluid-containing bacteria and pus drain out. This can take several weeks, so you might be sent home with the drain in place as well as antibiotics.

When the abscess is drained and the infection and inflammation are controlled, your doctor will perform the surgery.

Once your ruptured appendix is removed or a drain is put into an abscess, you’ll need antibiotics for a while. The first several doses will be given through your veins at the hospital. Then you’ll take them by mouth when you leave the hospital.

You typically take antibiotics for up to two to four weeks, depending on how bad the peritonitis or abscess was.

Open surgery (instead of laparoscopic) is almost always used for a ruptured appendix. This is so your doctor can be sure that all of the infection has been cleaned out of the abdominal cavity. It can take four to six weeks to fully recover from surgery. It’ll be longer if you have a drain inserted.

For a few days after surgery or after a drain is placed, you may be given strong prescription pain medication. After that, you can usually manage the pain with over-the-counter medications, like ibuprofen (Advil) or acetaminophen (Tylenol).

You’ll usually be encouraged to be up and walking as soon as possible after surgery. It takes a couple days for your intestines to start working again after surgery, so you may have a very limited diet until that happens. By the time you’re discharged from the hospital, you should be able to eat your usual diet.

Keep your incision clean and dry. Avoid taking a bath or shower until your doctor says it’s fine to do so.

Avoid lifting anything heavy or participating in sports or other strenuous activities for four to six weeks after open surgery. You should be able to return to work or school a week or so after surgery, depending on how you feel.

Without prompt or appropriate treatment, a ruptured appendix is a life-threatening condition. The outcome is often poor.

It’s a different story for a promptly and appropriately treated ruptured appendix. When you know the symptoms, seek medical attention right away, and receive the correct diagnosis, you should fully recover from your ruptured appendix.

Because of this, it’s crucial to see a doctor if you’re having any symptoms of appendicitis.

There’s no way of knowing when or if appendicitis will occur, so you can’t prevent it. However, you can avoid a rupture if appendicitis is treated right away.

The key is to be aware of the symptoms of appendicitis. If you develop them, seek medical attention immediately.

Even if you have symptoms that seem like appendicitis but you’re not sure, see your doctor right away. It’s better to find out it’s not appendicitis than to wait and have your appendix rupture.