Most people who slip and fall get up, dust themselves off, and move on with their day. Maybe there's a bruise or a sore spot, but nothing that seems worth a trip to the emergency room. But here's what many don't realize: some of the most dangerous injuries from falls don't show up right away, and the symptoms that do appear can seem completely unrelated to the accident.
Internal injuries are among the most serious complications from slip and fall accidents, and they're also among the most frequently missed. Unlike a broken bone or a gash that needs stitches, internal organ damage or internal bleeding can develop quietly as you're assuming everything is fine. By the time obvious symptoms appear, the injury may have progressed to a life-threatening stage.
Why Internal Injuries Happen From Falls
You don't need to fall from a significant height to suffer internal damage. Medical research has documented severe liver lacerations, internal bleeding, and traumatic brain injuries from falls that happened while someone was simply standing or even sitting down. The human body, despite its resilience, contains organs that are vulnerable to the kind of sudden impact that occurs during a fall.
When you fall, your body experiences rapid deceleration. Internal organs, which aren't rigidly attached to your skeletal structure, continue moving even after your body has stopped. This creates a shearing force that can tear tissue, rupture blood vessels, or cause organs to collide with bone. The liver, positioned beneath the lower ribs, is particularly susceptible to this type of injury. The spleen, kidneys, and brain are also commonly damaged in falls.
What makes these injuries especially dangerous is that they often occur without any external signs of trauma. You might not have a single visible bruise on your abdomen, yet be bleeding internally. The abdominal cavity can conceal significant blood loss before symptoms become obvious.
What Symptoms Should You Watch For Immediately After a Fall?
The minutes and hours immediately following a fall are critical. Your body will often give you warning signs that something is wrong internally, but these signs can be subtle or easily dismissed as simple soreness from the impact.
Abdominal pain or tenderness is one of the most important symptoms to take seriously. If pressing on your stomach causes pain, or if you notice pain that seems to spread across your abdomen, you need medical evaluation. Pay attention to whether your abdomen feels rigid or tense to the touch, which can indicate internal bleeding or organ injury. Some people describe a feeling of fullness or distension in their abdomen after a fall, which can signal blood accumulating in the abdominal cavity.
Changes in your vital signs matter more than most people realize. If you feel lightheaded, dizzy, or like you might faint, your blood pressure may be dropping due to internal bleeding. A rapid heartbeat or feeling like your heart is racing can indicate your body is trying to compensate for blood loss. Rapid or shallow breathing, or difficulty catching your breath, should prompt immediate medical attention.
Your skin can tell a story about what's happening inside your body. Skin that feels cold or clammy, or that looks unusually pale, suggests your circulation is compromised. If the whites of your eyes appear pale rather than their normal color, this can indicate significant blood loss.
How Head Injuries Present Differently
Falls are the leading cause of traumatic brain injury in the United States, accounting for more than a third of all non-fatal TBIs. Among older adults, falls are the leading cause of brain injury deaths. Yet head injuries from falls often present with symptoms that people don't immediately connect to their accident.
A headache that develops after a fall should never be dismissed as "just a bump on the head." While many headaches after minor head trauma are benign, they can also signal bleeding inside the skull. Pay attention to whether the headache gets worse over time, rather than better, and whether it's accompanied by other symptoms.
Changes in mental status can be subtle. You might feel confused, have trouble concentrating, or find yourself asking the same questions repeatedly. Family members might notice that you're acting "off" or not quite yourself. Some people experience memory problems, particularly difficulty remembering the fall itself or events immediately before or after it.
Nausea and vomiting after a head injury are concerning symptoms that warrant medical evaluation. Drowsiness or difficulty staying awake, especially if it worsens over time, can indicate increasing pressure inside the skull. Seizures or convulsions at any point after a head injury require emergency care.
Some neurological symptoms are more obvious: slurred speech, weakness on one side of the body, loss of coordination, or vision changes. But even subtle changes, like one pupil appearing larger than the other, can signal a serious brain injury.
The Deceptive Nature of Gastrointestinal Symptoms
Here's something that catches even medical professionals off guard: internal organ injuries frequently present with symptoms that look exactly like a stomach bug. Nausea, vomiting, and loose stools after a fall are often dismissed as coincidental illness or attributed to stress from the accident. In reality, these symptoms can indicate serious internal injuries.
When organs are damaged or when internal bleeding reduces blood flow to the intestines, the digestive system reacts. This can cause ischemic enteritis (inflammation from insufficient blood flow) or ischemic hepatitis (liver inflammation from reduced circulation). The resulting symptoms, feeling nauseous, vomiting, or having diarrhea, mirror common gastrointestinal illnesses and are frequently misdiagnosed.
If you develop these symptoms within hours or days of a fall, particularly if you also have abdominal pain or tenderness, they should be evaluated as potentially serious. The timing matters. A stomach bug that happens to start the same day you fell is certainly possible, but when trauma and gastrointestinal symptoms occur together, medical providers need to rule out internal injury.
When Symptoms Show Up Hours or Days Later
One of the most dangerous aspects of internal injuries is their potential for delayed presentation. You can feel relatively fine immediately after a fall, only to develop serious symptoms hours or even days later as an injury worsens or as blood slowly accumulates.
Internal bleeding doesn't always happen all at once. A tear in an organ or blood vessel might initially be small, with bleeding that's slow enough that your body can initially compensate. Over time, though, the bleeding continues or the injury worsens, and symptoms begin to emerge. A hematoma (collection of blood) might enlarge gradually, eventually causing pain or putting pressure on other organs.
This delayed presentation is particularly common with brain injuries. A subdural hematoma, where blood collects between the brain and skull, can develop slowly. Older adults are especially susceptible to this type of injury because the veins in the brain become more fragile with age and there's more space for blood to accumulate before it causes symptoms. Someone might seem fine for days or weeks after a fall, then develop confusion, headaches, or personality changes as the hematoma grows.
Progressive symptoms should always raise concern. If pain that was mild initially becomes more severe, if you develop new symptoms that weren't present right after the fall, or if symptoms that seemed to be improving suddenly worsen, these patterns suggest an injury that's evolving rather than healing.
Who Faces the Highest Risk of Serious Internal Injuries?
Not everyone who falls faces the same level of risk for internal injuries. Understanding the factors that increase danger can help you make informed decisions about whether to seek immediate medical care.
Age plays a significant role in injury severity. Older adults face substantially higher risks from falls because bones become more fragile and physiologic reserve decreases with age. The annual incidence of falls among older adults living in the community is about 32%, with nearly a quarter of those falls causing severe injuries. For people over 80, the annual fall rate can reach 50%. Falls from even minimal heights can cause serious internal injuries in elderly individuals that might not harm a younger person as severely.
If you have rib fractures from your fall, particularly involving ribs 5 through 8, this increases your risk for liver injury. Ribs 7 through 11 protect the spleen and other abdominal organs, and fractures in this area should prompt careful evaluation for internal damage. Sometimes rib fractures aren't immediately obvious but can be detected by subcutaneous emphysema, which is air trapped under the skin that creates a crackling sensation when touched.
Medications affect your risk profile significantly. If you take blood thinners like warfarin, apixaban, or rivaroxaban, or antiplatelet medications like aspirin or clopidogrel, you're at increased risk for serious bleeding from even minor trauma. That said, severe internal injuries absolutely can and do occur in people not taking these medications, so their absence doesn't mean you're safe.
Underlying health conditions matter too. If you have liver disease, your liver is more vulnerable to injury. Blood clotting disorders increase bleeding risk. Conditions that affect your bones, like osteoporosis, make fractures more likely, and those fractures can damage nearby organs.
What Medical Tests Can Detect Internal Injuries?
When you seek medical care after a fall, several diagnostic tools can identify internal injuries, each with different strengths and limitations:
Physical examination is the starting point. A doctor will check your vital signs: blood pressure, heart rate, respiratory rate, and level of consciousness. They'll examine your abdomen for tenderness, rigidity, or signs of internal bleeding. They'll assess your neurological function after any fall involving head trauma. But physical examination alone has limitations, it can miss injuries that aren't yet causing obvious symptoms.
Blood tests provide important clues about internal injury. If your liver enzymes (ALT and AST) are elevated, this suggests liver damage. The presence of blood in your urine (hematuria) can indicate kidney injury. Low hemoglobin or hematocrit levels suggest blood loss. A base deficit, which measures acid in your blood, can indicate shock from internal bleeding. These aren't perfect tests; they can be normal even with significant injury, especially in the early hours after a fall, but abnormal results significantly increase the likelihood that internal injury is present.
A FAST exam (Focused Assessment with Sonography in Trauma) uses ultrasound to look for free fluid, usually blood, in the abdomen. It's quick, non-invasive, and can be done at the bedside. The test is very specific, meaning if it shows fluid, there's a high likelihood of internal bleeding. However, its sensitivity is lower, it can miss injuries. A normal FAST exam doesn't rule out internal organ damage, which is why it's often followed by other testing if suspicion remains high.
CT scanning is the gold standard for detecting internal injuries. A contrast-enhanced CT of the chest and abdomen can reveal liver lacerations, organ hematomas, internal bleeding, and other injuries with high accuracy. CT can grade the severity of organ injuries and help doctors determine whether surgery is needed. The main downsides are radiation exposure and the time and resources required, but for serious falls or when symptoms suggest internal injury, CT scanning is invaluable.
In some cases, diagnostic peritoneal lavage may be used. This involves inserting a catheter into the abdominal cavity and checking for blood or other signs of organ injury. It's less commonly used now that CT scanning is widely available, but it remains useful in certain situations.
Understanding the Medical Stakes
The statistics around internal injuries from falls are sobering and worth understanding if you're deciding whether symptoms warrant medical attention.
Liver injuries from blunt trauma, which includes falls, carry mortality rates that range from 4% to 15% for moderate to severe injuries (grade III on the organ injury scale). About 81% of patients with these injuries require surgery, and 18% need blood transfusions. The liver's rich blood supply means that lacerations can lead to rapid, massive blood loss.
Traumatic brain injuries result in approximately 288,000 hospitalizations annually in the United States, with falls being the primary cause. Among older adults, falls cause 80% of TBI-related hospitalizations. These aren't just statistics; they represent real people whose lives are permanently altered or ended by what seemed like a simple fall.
Falls from heights under one meter (about three feet) have resulted in trauma-related deaths. Falls from standing height or even from a seated position have caused fatal internal injuries. The phrase "it wasn't a bad fall" can be dangerously misleading when it comes to internal injury risk.
The mortality associated with internal injuries often results not from the injury itself being untreatable, but from delays in diagnosis and treatment. When internal bleeding is caught early, interventions like surgery or transfusion can be lifesaving. When it's missed because symptoms were dismissed as minor, the outcome can be tragic.
What Property Owners' Responsibilities Mean for Your Situation
If your fall happened on someone else's property, questions about premises liability naturally arise. Under New York law, property owners have a duty to maintain reasonably safe conditions and to warn visitors about dangers that aren't obvious. However, establishing liability isn't as straightforward as simply having fallen on someone else's property.
Property owners are generally liable for injuries resulting from negligent maintenance or failure to address known hazards. But they're not automatically responsible for every accident that occurs on their premises. New York law specifically limits liability except in cases of willful or malicious failure to guard against or warn of dangerous conditions.
The distinction between legitimate injury claims and exaggerated or fraudulent claims has become a significant issue in New York, which reportedly has the highest number of questionable slip-and-fall claims in the United States according to insurance industry data. This has made insurance companies and property owners particularly skeptical of these cases.
When internal injuries are involved, proper documentation becomes crucial. Security camera footage can establish when and how a fall occurred. Medical records documenting the extent and timing of injuries provide objective evidence. The severity of internal injuries, confirmed by CT scans and other diagnostic tests, can distinguish legitimate serious injury cases from minor accidents.
If you've suffered internal injuries from a fall on someone else's property, the strength of your claim depends on several factors: whether a dangerous condition existed, whether the property owner knew or should have known about it, whether you were on the property legally, and whether the condition was something a reasonable property owner would have addressed. The nature and severity of your injuries, particularly when documented by medical imaging and treatment records, play a significant role in case evaluation.
When to Seek Medical Care After a Fall
The decision about when to seek medical attention after a fall should err heavily on the side of caution, especially given the potential for serious internal injuries from seemingly minor accidents.
Seek immediate emergency care if you experience any of the following:
- Severe abdominal pain
- Signs of shock (rapid heartbeat, low blood pressure, confusion, pale or clammy skin)
- Difficulty breathing
- Severe headache
- Loss of consciousness
- Vomiting
- Seizures
- Any neurological symptoms like weakness, numbness, or vision changes
These symptoms suggest potentially life-threatening injuries that require urgent intervention.
Seek medical evaluation within hours if you have:
- Moderate abdominal pain or tenderness
- Persistent nausea or vomiting
- Blood in your urine or stool
- Bruising that develops on your abdomen
- Rib pain or difficulty taking deep breaths
- Any head injury in an elderly person or someone taking blood thinners
Even if your symptoms seem mild, certain circumstances warrant medical evaluation. If you're over 65, taking anticoagulant medications, have a history of liver disease or blood clotting disorders, or fell from more than your standing height, getting checked out is prudent. The same applies if you hit your head during the fall, landed on your abdomen or side, or have rib tenderness or fractures.
When in doubt, get evaluated. The cost and inconvenience of an unnecessary medical visit pale in comparison to the consequences of a missed internal injury. Emergency room physicians and primary care doctors are accustomed to evaluating patients after falls, and they'd rather see you unnecessarily than have you suffer a preventable complication at home.
What Happens if Symptoms Develop Later?
If you initially felt fine after a fall but develop concerning symptoms later, don't hesitate to seek care just because time has passed. Medical providers need to know about the fall, even if it was days or weeks ago, because it completely changes the diagnostic considerations.
Be specific about your symptoms and their progression. Explain when the fall occurred, what symptoms you experienced immediately afterward, and how your current symptoms developed. Mention if symptoms seemed to improve then worsened, if new symptoms appeared, or if existing symptoms became more severe.
Don't minimize your symptoms or talk yourself out of seeking care because you feel like you're overreacting. People with serious internal injuries have convinced themselves they were fine only to deteriorate rapidly. Trust your instincts if something feels wrong.
If you visit your doctor or an urgent care center and your symptoms worsen after that visit, return for reevaluation or go to an emergency room. Medical conditions evolve, and what seemed minor can become serious. There's no shame in coming back if you're not improving or if you're getting worse.
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Summing It Up
Internal injuries from slip and fall accidents represent a genuine medical emergency that's too often recognized too late. The gap between when an injury occurs and when it's diagnosed can be the difference between a full recovery and a tragic outcome.
Your body will usually tell you something is wrong, but the language it speaks isn't always clear. Abdominal pain, changes in mental status, unexplained gastrointestinal symptoms, and progressive worsening of any symptom after a fall all deserve medical evaluation. The fact that you didn't fall far, that you were able to get up and walk, or that you don't look injured externally doesn't mean you're safe.
For older adults, people on blood thinners, and anyone with underlying health conditions, the threshold for seeking evaluation should be even lower. The injuries that can result from falls in these populations are disproportionately severe compared to the mechanism of injury.
If you've suffered internal injuries from a fall that occurred on someone else's property, proper medical documentation is essential not just for your health, but potentially for any legal action you might need to take. But that's secondary to getting the care you need to recover.
The most important thing to remember is this: when it comes to potential internal injuries after a fall, waiting and watching isn't safe. Medical evaluation is. The worst-case scenario isn't the embarrassment of going to the emergency room for something that turns out to be minor. The worst-case scenario is not going when you actually need to.
