Post-Appendectomy Pain: Symptoms Three Months Later

It is not uncommon to experience pain three months after an appendectomy. Some patients may have lingering discomfort due to factors such as scar tissue formation, nerve irritation, or other complications. If the pain persists or worsens, it is advisable to consult a

Hello, doctor.
I had an appendectomy on July 3rd, and since then, I have been experiencing bloating and pain in my lower right abdomen.
The pain sometimes feels like bloating and at other times like a dull ache.
When I touch the area, it feels hard.
I have also been experiencing persistent burping since the surgery.
I went to the emergency room in early September due to pain in my lower right abdomen and pain in my lower back on the right side.
I had a kidney ultrasound, which showed hydronephrosis.
Is there a connection? I also had an abdominal ultrasound that came back normal.
The doctor prescribed me medication for my stomach and for gas.
I am unsure about what to do next.

Mr. Wang, 30~39 year old female. Ask Date: 2023/10/27

Dr. Chen Jiaming reply Surgery

It has been three months post-surgery, and based on your symptoms, it seems highly likely that you are experiencing intestinal bloating.
After appendicitis treatment with antibiotics, the gut microbiota is often altered, and an increase in gas-producing bacteria can lead to bloating.
Additionally, postoperative adhesions may cause irregular intestinal motility.

You can try using commercially available probiotic yogurt or probiotics to gradually improve and restore your gut microbiota.
As for Western medicine, you may consider medications that reduce bloating (by decreasing the surface tension of gas in the intestines) to facilitate gas expulsion.
Furthermore, it is advisable to reduce the intake of foods that are prone to fermentation or bloating, and to practice mindful eating by chewing slowly.
The examination of your kidneys is due to your symptoms resembling those caused by kidney stones displacing and causing ureteral colic.
An ultrasound is necessary to confirm whether there is any obstruction leading to hydronephrosis.
As for renal cysts, they are common benign lesions and are generally not related to stones or obstruction.
I hope this information is helpful to you.

Reply Date: 2023/10/27

More Info

Post-appendectomy pain can be a complex issue, especially when symptoms persist several months after surgery. It’s important to understand that while some discomfort is expected after an appendectomy, ongoing pain, particularly if it is localized and associated with other symptoms, warrants further investigation.

From your description, it seems you are experiencing a combination of pressure-like pain and discomfort in the right lower abdomen, which can sometimes feel hard to the touch. This could be due to several factors related to your surgery and recovery process.
1. Post-Surgical Healing: After an appendectomy, the body goes through a healing process that can take time. Scar tissue, or adhesions, can form as part of this healing process. These adhesions can sometimes cause discomfort or pain in the abdominal area. The sensation of hardness you feel could be related to the healing tissue or even residual inflammation.

2. Gastrointestinal Issues: The fact that you are experiencing bloating and have been prescribed medication for gas suggests that there may be gastrointestinal involvement. After abdominal surgery, the digestive system can sometimes take time to return to normal function. This can lead to symptoms such as bloating, gas, and discomfort. It’s also possible that the surgery may have affected your bowel motility temporarily.

3. Possible Complications: While it’s less common, complications such as an abscess or infection can occur after an appendectomy. If you notice worsening pain, fever, or any other concerning symptoms, it’s crucial to seek medical attention promptly.
4. Kidney Issues: You mentioned having a kidney ultrasound that showed a cyst. While simple renal cysts are usually benign and often do not cause symptoms, if there is any associated pain in the flank area, it may be worth discussing with your physician. The pain in your right lower abdomen could potentially be referred pain from the kidney, especially if there are any issues such as hydronephrosis (swelling of a kidney due to a build-up of urine).

5. Follow-Up Care: Since you have already sought emergency care and had imaging done, it may be beneficial to follow up with your primary care physician or a gastroenterologist. They can help assess whether your symptoms are related to the surgery, gastrointestinal issues, or something else entirely.
In summary, while some discomfort after an appendectomy is normal, ongoing pain, especially if it is accompanied by other symptoms like bloating or changes in bowel habits, should be evaluated further. It’s essential to maintain open communication with your healthcare providers, share all your symptoms, and ensure that you receive a thorough evaluation to rule out any complications or other underlying issues. If your symptoms persist or worsen, don’t hesitate to seek further medical advice.

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