A fall resulting in abdominal pain raises immediate concerns about internal injury. The abdomen houses many organs protected only by muscle and skin, making it vulnerable to impact. Pain can stem from a wide range of causes, from minor, superficial injuries to severe, life-threatening internal trauma. Because the consequences of blunt abdominal trauma can be immediate or delayed, assessing the type and location of the pain, along with any accompanying symptoms, is the first step in determining the injury’s severity.
Superficial Pain: Bruising and Muscle Strain
The most frequent causes of abdominal pain following a fall relate to the outer layers of the body. When a person falls, the body’s natural reaction is to tense the core muscles in anticipation of impact, which can lead to a muscle strain. This straining, or “pulled muscle,” causes sharp, localized pain that worsens when the abdominal muscles are contracted, such as when sitting up, coughing, or laughing.
The direct impact of the fall often causes contusions, commonly known as bruising, to the skin and underlying tissues. A contusion results from damaged small blood vessels that leak blood into the surrounding tissue, causing visible discoloration and tenderness. This superficial pain is localized to the area of impact and is aggravated by touch or movement. Generally, this type of pain improves rapidly within a few days and rarely indicates a serious internal injury.
Internal Organ Damage: What Causes Severe Pain
A fall delivering blunt force trauma can cause serious internal injury to the abdomen’s solid and hollow organs. Solid organs like the spleen, liver, and kidneys are most commonly affected because their dense, fixed structure makes them susceptible to tearing or laceration upon impact. The spleen, located in the upper left abdomen, is particularly vulnerable to rupture and is the most common source of massive bleeding in blunt abdominal trauma.
Damage to these solid organs risks significant internal bleeding, or hemorrhage, into the abdominal cavity. This internal bleeding can lead to hemoperitoneum, where blood accumulates around the organs, but the pain may not be immediately obvious or severe. Blood leaking from a damaged organ, such as the spleen, can irritate the diaphragm, causing referred pain. This discomfort is often felt in the left shoulder, known as Kehr’s sign, which indicates a severe splenic injury.
Blunt force can also injure hollow organs like the small or large intestine. These organs are more mobile and elastic, but a sudden rise in internal pressure from the impact can cause them to rupture. If their contents spill into the abdominal space, it can quickly lead to infection and inflammation of the abdominal lining, known as peritonitis. Injury to the kidneys, which sit toward the back below the ribcage, may result in visible blood in the urine.
Immediate Action: Warning Signs Requiring Emergency Care
Any significant abdominal pain following a fall warrants immediate medical evaluation. Several specific warning signs indicate an urgent, life-threatening emergency:
- Pain that progressively worsens over a period of hours, rather than improving, suggests ongoing internal injury or bleeding.
- The presence of abdominal rigidity, often described as “board-like” stiffness, which is a concerning sign of internal inflammation or peritonitis.
- Systemic signs of shock, reflecting major trauma and blood loss, such as a rapid heart rate, clammy or pale skin, and altered mental status.
- Vomiting, especially if the vomit contains blood.
- Inability to pass urine or visible blood in the urine.
- Pain that disappears and then returns hours or days after the initial fall, suggesting a ruptured hematoma and delayed catastrophic hemorrhage.
How Doctors Diagnose Abdominal Trauma
When a patient arrives at the emergency department with suspected abdominal trauma, the medical team begins a rapid and systematic diagnostic process. The initial assessment includes a focused physical examination and laboratory work, specifically blood tests to check hemoglobin and hematocrit levels, which can indicate acute blood loss. The first-line imaging tool for trauma is the Focused Assessment with Sonography for Trauma (FAST) exam.
This ultrasound-based exam is performed at the bedside and quickly checks four specific areas for the presence of free fluid, which is typically blood in the context of trauma. A positive FAST exam, indicating free fluid, is a strong indicator of internal bleeding and helps guide rapid decisions, especially in patients who are hemodynamically unstable. For stable patients, the gold standard for detailed diagnosis is a Computed Tomography (CT) scan with intravenous contrast. The CT scan provides high-resolution images that precisely locate and grade injuries to solid organs like the liver and spleen, and can identify injuries to the kidneys or bowel.