Perhaps you caught your heel on a curb in Deep Ellum, or slipped on a slick tile floor in a downtown Dallas office building. You hauled yourself upright, dusted yourself off, and figured you were fine. There’s a catch though. Feeling all right in the immediate aftermath of a fall does not mean you’re truly safe.

Internal injuries can sneak up on you, but the red flags are often subtle and misleading. It’s the elusiveness of these injuries that can be so perilous.

We tend to expect to experience immediate pain if there’s truly cause for concern. We assume that our body will warn us if something is broken or severed. However, sometimes our bodies respond by pumping huge amounts of adrenaline to cope with the shock, which can mask pain and other internal injury symptoms for hours or even days after the fall. It takes that long for the symptoms to become obvious enough to seek medical care, by which point the situation is typically already dire.

We encounter this pattern in fall injury cases all the time in the Dallas community.

Say, for example, a customer falls at a grocery store in Oak Lawn and walks away. A couple of days later they arrive at the emergency room with severe internal bleeding. The injury was not minor, the fall was.

According to the Centers for Disease Control and Prevention, falls are the leading cause of traumatic brain injuries and a top cause of emergency room visits across all age groups. Many falls result in internal injuries that cannot be detected from the outside: internal bleeding, bruised organs, internal organ tears, and abdominal bleeding to name a few. These types of injuries are hidden beneath the skin.

Organ injury can be caused by any major organ in the body including the spleen, kidney, liver, or lungs. It can result in brain bleed or fractured ribs that puncture soft tissue. There are none of the typical indications of injury that you can see from the outside; no lacerations or bruising that you can point to as the source of your problem.

While some warning signs are immediate, others can show up hours after you fall, which is why the possibility of organ damage from falls can go so easily overlooked.

Start with abdominal pain or bloating. You may feel like there is pressure, or there may be tenderness or pain to the touch in the area, both of which can be a sign of a lacerated spleen, or a torn liver. This injury, as mentioned above, is common among those who fall in concrete steps or tile floors.

Next, look for signs of dizziness. Feeling somewhat lightheaded when standing up is normal, but if this feeling of imbalance or dizziness persists 20 to 30 minutes after a fall, you should take it seriously. A sudden drop in blood pressure from internal bleeding can cause a dizzy feeling like you’re going to faint.

Blood in your stool or vomit. Blood in urine, stool, or the vomit after a fall is something to take very seriously. It is usually a sign of a kidney injury, bladder tear, or a tear in your digestive tract. Again, don’t just wait to see if it happens again.

Here in Dallas, we experience many days of summer heat, when we might expect to see someone become dehydrated, faint, weak, etc. But if you fell that morning, you should not attribute those symptoms to a heat stroke.

Bruises that grow or darken is also something to be aware of. A normal bruise, such as one you get bumping against your kitchen table, typically stays the same size. When you notice your bruises increasing in size, change to a darker color, or appear on parts of your body far removed from the injury location, you should get it checked out by a doctor. This may include bleeding under the skin or in or around an organ. Chest pain or difficulty breathing warrant a special mention of their own. A rib fracture could occur during a fall, and you could be unaware of it. Rib fractures can puncture a lung. Deep breaths could hurt like a sharp pinprick, and it may become difficult to breathe as you walk from your car to your front door. There’s confusion, too. If a person who has fallen seems “off,” that should be taken seriously. Slurring, inattention, unusual drowsiness; these can all point to a brain bleed. It’s an especially great risk for older individuals. Falls, per the Centers for Disease Control and Prevention, are the number one cause of traumatic brain injuries for adults 65 and up. One particular scenario we see: a person slips on a wet floor in their Oak Cliff home, feels great for a couple of hours, and then starts vomiting later that evening. By the time the person arrives in the ER, they’ve developed internal bleeding that could have been treated earlier if they’d gotten checked out sooner. So, what are you seeing in each one of those cases? Well, one similarity among these serious signs is how they get progressively worse, and not better. A headache that gets worse. Pain that spreads. Exhaustion that gets deeper. Your body is telling you things are not healing by themselves. Don’t convince yourself it’s not worth a doctor’s visit. “I just fell” is a statement we hear every single day. But a tumble that involves a fall of even just a few feet can injure the organs, blood vessels, and bones of the interior body that aren’t always apparent from the outside. If you’re experiencing one of these signs or several in combination following a fall, treat them as an emergency. The best opportunity to diagnose and treat this kind of injury is when it is caught at an early stage before it becomes life-threatening.

Delayed Symptom Occurrence

Some Signs Don’t Appear Until Hours or Days Have Passed This is the piece of this that worries us the most: The person falls, feels fine, heads home, and gets sick or injured. In fact, not all falls result in injuries that show up immediately. Adrenaline courses through the body after a trauma and that is responsible for blocking or masking pain and more. We see this pattern quite a bit in our practice: Someone slips on a wet floor in a Dallas parking lot, and he gets up, shakes off the dirt off of himself, and says, “I’m good to go.” A day or two later, and he has ended up in the ER with an internal bleed. He wasn’t always aware he’d been injured at the site of his fall until he started showing those telltale signs of a serious brain or internal injury. That delay is what makes a brain injury in a fall particularly dangerous. Brain swelling, as in the case of this injury, could occur progressively over the hours after the trauma. Even a modest split of your spleen can seep at an unhurried pace that remains undetected until your blood pressure declines. A cracked rib might only result in some soreness until you start moving and it punctures your lung. These aren’t hypothetical circumstances. Falls are actually the number one cause of traumatic brain injury in the U.S., according to the Centers for Disease Control and Prevention.

So, what can we expect to look out for when delayed symptoms occur? Check out this list of delayed symptoms to monitor in the hours and days after you have fallen: