10 Critical Peritonitis Symptoms You Should Never Ignore

Peritonitis is a serious medical condition characterized by inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. This condition requires immediate medical attention as it can quickly become life-threatening if left untreated. Understanding the symptoms of peritonitis is crucial for early detection and prompt treatment.

The peritoneum plays a vital role in protecting your abdominal organs and supporting immune function within the abdomen. When this membrane becomes inflamed due to bacterial or fungal infection, it can lead to severe complications including sepsis, organ failure, and death. Recognizing the warning signs early can make the difference between a full recovery and serious health consequences.

In this comprehensive guide, we’ll explore the most common and critical symptoms of peritonitis, helping you understand when to seek emergency medical care. Whether the condition develops suddenly (acute peritonitis) or gradually over time (chronic peritonitis), knowing these symptoms can save lives.

1. Severe Abdominal Pain

The most prominent and often first symptom of peritonitis is intense abdominal pain. This pain typically begins suddenly and becomes progressively worse over time. Unlike ordinary stomach discomfort, the pain associated with peritonitis is usually severe and constant.

Characteristics of peritonitis-related abdominal pain include:

• Sharp or stabbing sensation: The pain is often described as knife-like rather than dull or cramping
• Worsening with movement: Any motion, coughing, or touching the abdomen intensifies the pain
• Widespread distribution: The pain may start in one area but typically spreads across the entire abdomen
• Constant nature: Unlike cramping pain that comes and goes, peritonitis pain is continuous and unrelenting

Patients often find relief only by lying completely still with their knees drawn up toward their chest. The abdominal muscles may become rigid and board-like as the body attempts to protect the inflamed peritoneum, a condition known as “guarding.”

2. Abdominal Tenderness and Rigidity

When peritonitis develops, the abdominal wall becomes extremely sensitive to touch and may feel abnormally hard or rigid. This symptom is medically referred to as “abdominal guarding” and “rebound tenderness.”

Rebound tenderness is a classic sign where pressing on the abdomen and then quickly releasing the pressure causes a sharp increase in pain. This occurs because the inflamed peritoneum is being irritated by the movement of the abdominal organs when pressure is released.

The rigidity occurs due to involuntary contraction of the abdominal muscles, creating a board-like hardness across the belly. This is the body’s natural defense mechanism attempting to protect the inflamed area from further injury. Healthcare providers often test for this rigidity during physical examination as it’s a key diagnostic indicator of peritonitis.

3. Abdominal Swelling and Bloating

Distension or swelling of the abdomen is another hallmark symptom of peritonitis. The inflammation causes fluid to accumulate in the abdominal cavity, a condition called ascites, which leads to visible swelling and a sensation of fullness.

The bloating associated with peritonitis differs from normal digestive bloating in several ways:

• Severity: The swelling is typically more pronounced and progressive
• Accompanying pain: It occurs alongside severe pain rather than mild discomfort
• Tightness: The abdomen feels extremely tight and stretched
• Rapid onset: The bloating develops quickly rather than gradually

This accumulation of fluid not only causes physical discomfort but can also interfere with breathing as the swollen abdomen presses against the diaphragm. Patients may notice their clothing feels tighter around the waist, and the abdomen may appear visibly distended.

4. Nausea and Vomiting

Persistent nausea accompanied by vomiting is a common symptom of peritonitis. The inflammation of the peritoneum disrupts normal digestive function and can trigger the body’s vomiting reflex as it attempts to respond to the infection.

The vomiting in peritonitis cases tends to be:

• Persistent: It doesn’t resolve with typical home remedies or rest
• Severe: May be forceful and frequent
• Progressive: Often worsens as the condition advances
• Accompanied by inability to keep anything down: Even small sips of water may be rejected

The constant nausea creates a loss of appetite, and patients typically have no desire to eat or drink. This symptom, combined with vomiting, can quickly lead to dehydration, which further complicates the condition. The vomiting may initially contain food particles but can progress to bile or other fluids as the stomach empties.

5. Fever and Chills

A high fever is one of the body’s primary responses to the infection causing peritonitis. The fever typically ranges from moderate to high-grade (above 100.4°F or 38°C) and is often accompanied by chills and shaking.

The fever in peritonitis reflects the body’s immune system attempting to fight off the bacterial or fungal infection within the abdominal cavity. Temperature fluctuations are common, with patients experiencing:

• Sudden spikes: Temperature can rise rapidly as the infection progresses
• Rigors: Uncontrollable shaking and teeth chattering despite feeling hot
• Alternating sensations: Feeling extremely hot followed by cold sweats
• Night sweats: Excessive perspiration that may soak through clothing and bedding

In some cases, particularly in elderly patients or those with weakened immune systems, the fever may be absent or lower than expected, which can make diagnosis more challenging. However, the presence of fever combined with other abdominal symptoms is a strong indicator of peritonitis requiring immediate medical evaluation.

6. Loss of Appetite

A sudden and complete loss of appetite is frequently reported by patients with peritonitis. This symptom goes beyond normal variations in hunger and represents a profound aversion to food and sometimes even liquids.

The loss of appetite occurs due to multiple factors:

• Pain interference: The severe abdominal pain makes the thought of eating unbearable
• Nausea: Constant queasiness eliminates any desire for food
• Systemic infection: The body’s inflammatory response suppresses normal hunger signals
• Bowel dysfunction: The inflammation disrupts normal digestive processes

Patients often report that even their favorite foods hold no appeal, and the smell of food may trigger or worsen nausea. This symptom contributes to rapid weight loss and weakness, as the body is unable to obtain necessary nutrients while simultaneously fighting a serious infection. The combination of inability to eat and increased metabolic demands from fighting infection can quickly lead to malnutrition and decreased strength.

7. Constipation or Inability to Pass Gas

Peritonitis often causes a significant disruption to normal bowel function, resulting in constipation and the inability to pass gas (flatulence). This occurs because the inflammation causes the intestines to slow down or stop moving altogether, a condition called ileus or paralytic ileus.

Key characteristics of this symptom include:

• Complete absence of bowel movements: No stool passage for an extended period
• No gas passage: Unable to pass flatus despite feeling bloated
• Absent bowel sounds: A healthcare provider listening with a stethoscope may hear little to no intestinal activity
• Increasing discomfort: The buildup of gas and stool adds to abdominal pain and distension

This symptom is particularly concerning because it indicates that the intestines have stopped functioning properly. The accumulation of gas and digestive contents in the immobilized intestines contributes to the severe bloating and pain. Some patients may experience diarrhea instead, particularly if the peritonitis is caused by certain types of infections, but constipation and inability to pass gas are more common presentations.

8. Rapid Heart Rate (Tachycardia)

An abnormally fast heart rate, medically termed tachycardia, is a common systemic response to peritonitis. As the infection progresses and the body enters a state of stress, the heart compensates by beating faster to deliver oxygen and immune cells to fight the infection.

The rapid heart rate in peritonitis typically manifests as:

• Resting heart rate above 100 beats per minute: Significantly elevated even without physical activity
• Palpitations: Awareness of the heart beating forcefully or irregularly
• Persistent elevation: The increased rate doesn’t normalize with rest
• Progressive worsening: May increase further as the infection advances

Tachycardia in peritonitis serves as a warning sign that the infection is affecting the entire body, not just the abdomen. It often accompanies other systemic symptoms like fever and low blood pressure. The heart works harder to maintain adequate circulation in the face of inflammation, fluid shifts, and potential dehydration from vomiting. This increased cardiac workload can be particularly dangerous for patients with pre-existing heart conditions.

9. Low Urine Output

Decreased urine production, known medically as oliguria, is a serious symptom that can develop in peritonitis cases. This occurs due to multiple factors including dehydration from vomiting, fluid shifts into the abdominal cavity, and the body’s stress response to severe infection.

Signs of decreased urine output include:

• Infrequent urination: Needing to urinate much less often than normal
• Small volumes: Producing only small amounts of urine when able to go
• Dark concentration: Urine appears darker yellow or amber in color
• Strong odor: More concentrated urine has a stronger smell

Reduced urine output is particularly concerning because it may indicate that the kidneys are being affected by the infection or that the patient is becoming severely dehydrated. The kidneys require adequate fluid volume and blood pressure to function properly. When peritonitis causes significant fluid loss or redistribution, kidney function can become compromised. In severe cases, this can progress to acute kidney injury, which is a medical emergency requiring immediate intervention.

10. Confusion and Altered Mental Status

In advanced or severe cases of peritonitis, patients may experience confusion, disorientation, or other changes in mental status. This symptom indicates that the infection has progressed to affect the entire body, potentially leading to sepsis or septic shock.

Mental status changes in peritonitis may present as:

• Confusion: Difficulty thinking clearly or understanding what’s happening
• Disorientation: Not knowing the time, place, or recognizing familiar people
• Drowsiness: Excessive sleepiness or difficulty staying awake
• Agitation: Unusual restlessness or combative behavior
• Slurred speech: Difficulty communicating clearly

These neurological symptoms occur because the severe infection and inflammation affect the brain’s function. Factors contributing to altered mental status include high fever, dehydration, electrolyte imbalances, decreased oxygen delivery to the brain, and toxins from the infection circulating in the bloodstream. The presence of confusion or any mental status change in a patient with suspected peritonitis is an emergency requiring immediate medical attention, as it suggests the condition has become life-threatening.

What Causes Peritonitis?

Understanding the underlying causes of peritonitis helps in recognizing risk factors and taking preventive measures. Peritonitis can be classified into two main types based on its cause: primary and secondary peritonitis.

Primary (Spontaneous) Peritonitis occurs when infection develops in the peritoneal fluid without an obvious source in the abdomen. Common causes include:

• Liver disease: Patients with cirrhosis and ascites are at high risk for spontaneous bacterial peritonitis
• Kidney disease: Those undergoing peritoneal dialysis can develop infections in the peritoneal cavity
• Weakened immune system: Conditions like HIV/AIDS or immunosuppressive medications increase infection risk

Secondary Peritonitis results from a rupture or perforation in the abdominal organs, allowing bacteria to enter the peritoneal cavity. Major causes include:

• Ruptured appendix: Appendicitis that progresses to rupture is a leading cause
• Perforated stomach ulcer: Gastric or duodenal ulcers can erode through the stomach or intestinal wall
• Diverticulitis: Infected pouches in the colon can rupture and leak contents into the abdomen
• Traumatic injury: Abdominal trauma from accidents, gunshot wounds, or stab wounds can damage organs
• Surgical complications: Peritonitis can develop after abdominal surgery if contamination occurs
• Inflammatory bowel disease: Crohn’s disease or ulcerative colitis can cause perforations
• Pancreatitis: Severe inflammation of the pancreas can lead to infected fluid collections
• Pelvic inflammatory disease: Infections of the female reproductive organs can spread to the peritoneum

Prevention Strategies

While not all cases of peritonitis can be prevented, several strategies can significantly reduce your risk of developing this serious condition:

For General Prevention:

• Treat infections promptly: Seek medical attention for abdominal pain, urinary tract infections, or other infections that could potentially spread
• Manage chronic conditions: If you have liver disease, kidney disease, or digestive disorders, work closely with your healthcare provider to manage these conditions effectively
• Don’t ignore warning signs: Seek immediate medical care for severe abdominal pain, especially if accompanied by fever or vomiting
• Practice good hygiene: Regular handwashing and food safety practices help prevent infections

For Peritoneal Dialysis Patients:

• Follow sterile technique strictly: Always use proper sterile procedures when performing dialysis
• Maintain equipment properly: Keep all dialysis equipment clean and in good condition
• Watch for warning signs: Report cloudy dialysis fluid, fever, or abdominal pain immediately
• Attend all follow-up appointments: Regular monitoring helps catch problems early
• Complete training thoroughly: Ensure you understand all aspects of safe dialysis procedures

For Those with Risk Factors:

• Limit alcohol consumption: Excessive alcohol use contributes to liver disease and cirrhosis
• Manage stomach ulcers: Take medications as prescribed and avoid triggers that worsen ulcers
• Eat a healthy diet: High-fiber diets may help prevent diverticulitis
• Avoid smoking: Smoking increases the risk of various conditions that can lead to peritonitis

Frequently Asked Questions

How quickly do peritonitis symptoms develop?

Peritonitis symptoms can develop suddenly within hours (acute peritonitis) or gradually over days to weeks (chronic peritonitis). Secondary peritonitis from a ruptured organ typically causes sudden, severe symptoms, while primary spontaneous peritonitis may have a more gradual onset. Regardless of the speed of onset, peritonitis always requires immediate medical attention.

Can peritonitis go away on its own?

No, peritonitis cannot resolve on its own and always requires medical treatment. Without prompt intervention, the condition will worsen and can lead to life-threatening complications including sepsis, organ failure, and death. If you suspect peritonitis, seek emergency medical care immediately.

Is peritonitis contagious?

No, peritonitis itself is not contagious and cannot be spread from person to person. However, some of the underlying infections that can lead to peritonitis, such as certain sexually transmitted infections causing pelvic inflammatory disease, can be contagious. The peritonitis develops as a complication within an individual’s body rather than spreading between people.

Who is at highest risk for developing peritonitis?

People at highest risk include those undergoing peritoneal dialysis for kidney disease, individuals with liver cirrhosis and ascites, those with inflammatory bowel disease, people with a history of abdominal surgery or trauma, and individuals with weakened immune systems due to conditions like HIV/AIDS or immunosuppressive medications.

How is peritonitis diagnosed?

Diagnosis typically involves a combination of physical examination, blood tests to check for infection and inflammation, imaging studies such as CT scans or ultrasounds to visualize the abdomen, and analysis of peritoneal fluid obtained through paracentesis. The doctor will assess symptoms, medical history, and test results to confirm the diagnosis.

What’s the difference between peritonitis and appendicitis?

Appendicitis is inflammation of the appendix and is actually one of the conditions that can lead to peritonitis if the appendix ruptures. Appendicitis typically begins with pain around the navel that moves to the lower right abdomen, while peritonitis causes more widespread abdominal pain and rigidity. A ruptured appendix allows bacteria to spill into the peritoneal cavity, causing peritonitis as a complication.

Can you survive peritonitis?

Yes, peritonitis is survivable with prompt medical treatment. However, the outcome depends heavily on how quickly treatment begins, the underlying cause, the patient’s overall health, and whether complications develop. Early recognition of symptoms and immediate medical care significantly improve survival rates and reduce the risk of long-term complications.

How long does recovery from peritonitis take?

Recovery time varies depending on the severity of the infection and the treatment required. Hospital stays typically range from several days to weeks. Full recovery may take several weeks to months after discharge, during which time patients gradually regain strength and normal digestive function. Following your healthcare provider’s instructions is essential for complete recovery.

References:

• Mayo Clinic – Peritonitis
• NHS – Peritonitis
• Johns Hopkins Medicine – Peritonitis
• National Center for Biotechnology Information – Peritonitis
• Cleveland Clinic – Peritonitis