The pain from inflammatory bowel disease (IBD), and especially Crohn’s disease, can be severe and last for days or longer. After being diagnosed with a form of IBD, abdominal pain might be thought of as part of the disease.

However, IBD is not the only reason for abdominal pain. Appendicitis is another common reason for abdominal pain. Knowing the difference between IBD pain and appendicitis pain is helpful because an inflamed appendix is a medical emergency.

Here’s how you can tell the difference.

	Acute Appendicitis	Ulcerative Colitis	Crohn’s Disease
Onset	Sudden, in hours to days	Gradual, sometimes over days or weeks, and chronic	Gradual, sometimes over days or weeks, and chronic
Pain	Begins at the belly button, then changes to the lower right side of the abdomen, worsens over 24-48 hours, and is more intense when moving or walking	Lower left side abdominal pain or cramping which might get better after going to the bathroom	Most commonly cramps or aching in the lower right abdomen, which may get worse after eting
Stool	Constipation or diarrhea is possible, but bloody stool is not a symptom	Diarrhea which may contain mucus or blood	Sometimes diarrhea, but usually without blood
Digestive symptoms	Nausea and vomiting start suddenly along with the abdominal pain	Nausea and vomiting are not typical	Nausea and vomiting are possible but not typical
Other symptoms	High fever	Fatigue and low fever	Fatigue and low fever

The appendix and IBD have a relationship that’s still being understood. Some other points about the appendix and IBD:

During a colectomy, the appendix is removed. The terminology around the intestines can be confusing. “Large intestine” and “colon” aren’t really the same thing, though we use the words interchangeably. The large intestine includes the cecum, colon, appendix, rectum, and anus.[1]

The appendix is connected to the first part of the colon. For that reason, when the colon comes out, such as to treat ulcerative colitis or Crohn’s disease, the appendix is also removed.

The appendix may play a role in IBD. It’s not well understood how yet, but having an appendectomy may affect the risk of IBD. Some studies show that children who had their appendix removed also had a lower risk of developing IBD.[2]

Sometimes appendicitis is treated with antibiotics instead of surgery. In one study, those who had antibiotics instead of surgery has a lower risk risk of ulcerative colitis, but not Crohn’s disease.[2]

Sources:

1. City of Hope. Colectomy. https://www.cancercenter.com/cancer-types/colorectal-cancer/treatments/surgery/colectomy
2. Kiasat A, Ekström LD, Marsk R, Löf-Granström A, Gustafsson UO. Childhood appendicitis and future risk of inflammatory bowel disease – A nationwide cohort study in Sweden 1973-2017. Colorectal Dis. 2022;24(8):975-983. doi:10.1111/codi.16128