There is typically pain and tenderness in the right iliac fossa in both typical and atypical (suppurative) appendicitis. Rebound tenderness may be present suggesting that there is some element of peritoneal irritation. Asking the patient to cough gently and point to the tender spot is the least painful way to localize the area of peritonitis. If the abdomen is involuntarily guarded (rigid), there should be a strong suspicion of peritonitis requiring urgent surgical intervention.