A medical history is taken and physical examination is performed to determine possible causes of abdominal pain. There are many reasons for abdominal pain besides appendicitis. These include gastroenteritis, indigestion, constipation, diverticulitis, gallbladder disease, hernias, ulcer disease, female reproductive system disease (including ovarian torsion [a twisted ovary], pelvic inflammatory disease, miscarriage of a pregnancy, and ruptured ovarian cysts), male reproductive system disease, bladder infection, kidney or bladder stones, and other less common problems. The abdominal pain usually associated with appendicitis often starts around the umbilicus (belly button), then concentrates in the lower right part of the abdomen. It is made worse by movement or by pressing on the abdomen and quickly releasing that pressure (rebound tenderness).