by Sue Kirelik, MD

What do I need to know about abdominal injuries?

  • Most serious abdominal injuries in kids occur in accidents, including car accidents, but they can also occur in sports.
  • Abdominal injuries make up less than 4 percent of youth sport injuries, but when they happen they can be serious.
  • Symptoms of abdominal injuries may not be obvious, so you need to know what to look for.

Abdominal Injuries in Youth Athletes

With almost 8 million high school students participating in sports each year, there are about 320,000 abdominal injuries in sports. Abdominal injuries occur most often in football, wrestling, ice hockey and lacrosse for boys and field hockey, soccer, basketball and gymnastics for girls. Abdominal injuries can also happen in skiing, snowboarding, bike riding and other recreational activities. Kids are more likely to injure abdominal organs than adults because the wall of the abdomen is thinner and the organs are not as well protected by the ribs. Injuries to the stomach, small and large intestine, spleen, liver, kidneys and pancreas can occur in sports. Injuries to liver and spleen can cause severe bleeding and can be life threatening. Symptoms of these abdominal injuries may be hard to recognize because sometimes the early symptoms are mild or seem to point away from the belly.

How do abdominal injuries happen in sports?

An injury to the abdominal organs can happen when there is a direct blow (blunt trauma) to the abdomen, such as an elbow or hard ball hitting the belly. It can also happen if the athlete is moving fast and is suddenly forced to stop, like with a tackle or fall. The body may stop but the organ in the belly can continue to move, causing tearing to the organ or blood vessels.

Spleen and liver injuries: The liver and spleen are the most commonly injured organs in sports. They are filled with blood and can cause severe bleeding when lacerated (cut). They can also be bruised (contusion) and the spleen can be ruptured. Symptoms of a liver and spleen injury include abdominal pain, nausea or vomiting. Bleeding in the abdomen can irritate the diaphragm, which can cause pain in the shoulder. Sometimes this is the only symptom so someone who has had a hit to his or her belly and now has shoulder pain needs to see a medical provider. Shock can develop from bleeding which causes fast heartbeat, rapid breathing, shortness of breath, as well as looking pale or grey and sweaty. Because bleeding sometimes takes time to develop the symptoms of abdominal injury might not show up for several hours.

Pancreas and bowel injuries: The pancreas, small or large bowel can be injured when there is a blow to the middle of the abdomen, at or near the belly button. A bike handlebar to the belly might seem minor but sometimes can cause a serious injury, bruising or lacerating the pancreas or bruising or perforating (causing a hole) the wall of the bowel. Symptoms might not show up until days to weeks after the injury when inflammation or infection develops from leaking of the bowel or pancreas. Patients develop abdominal pain that just doesn’t get better, sometime with fever, nausea or vomiting and pain with movement.

Kidney injuries: The kidneys can be injured in sports with a blow to the back or flank that causes bruising or laceration. These patients might have back or flank pain, nausea or vomiting and sometimes tea colored or red urine.

Abdominal Wall Muscle injuries: The muscle in the wall of the abdomen can get bruised with a direct blow or sudden contraction of the muscle. The injury causes pain with movement of the truck and tenderness over the bruised area. Because it can be hard to tell if the pain is coming from the muscle or a more serious injury in the abdomen it is important to have a medical evaluation with any abdominal pain even if you think it is just the muscle that is injured.

What other abdominal issues occur in sports?

“Stitch”: Almost every athlete has experienced a “stitch” where exercise causes pain in the side of the abdomen or shoulder that goes away within a few minutes when the exercise is stopped. This is technically known as “Exercise Induced Transient Abdominal Pain.” No one knows why someone gets a “stitch” but some physicians believe it is because the lining of the abdomen is irritated with exercise. You can prevent a “stitch” during exercise by strengthening core muscles or using a wide band to support the abdomen and torso might help prevent a “stitch.” Once the pain develops, try deep breathing, stretching the torso away from the side of the pain or bending forward to help it go away. The pain from a stitch should go away within 15 or 20 minutes. If it doesn’t you should see a medical provider.

Runners Diarrhea: Some athletes experience sudden diarrhea when running for a long time, which can be very distressing. We don’t know the exact cause of this, but if may be because running makes blood flow to the muscles and takes it away from the gut or because exercise makes digesting food travel through the bowel more quickly. A change in diet may help prevent runner’s diarrhea. Avoid drinks with a lot of sugar, like fruit juice or soda before exercise. If it continues despite diet changes you should see your medical provider.

“Wind Knocked Out”: A blow to the upper abdomen or lower mid chest can cause spasm of the diaphragm breathing muscle and will make the athlete feel like they can’t take a breath. When an athlete has their “wind knocked out,” it is very upsetting and can make the athlete feel panicky. Coaching on slow steading breaths can help it get better more quickly. Drawing up the legs at the hips and loosening any tight clothing may also help. The breathing should return to normal within a few minutes. If it doesn’t this may be a sign of a more serious injury and you should see a medical provider.

Playing sports with an enlarged spleen: There are illnesses that can cause the spleen to swell and become more fragile. The most common cause of an enlarged spleen is mononucleosis (mono). When the spleen is enlarged it is dangerous to participate in contact sports because a blow to the abdomen can cause the spleen to rupture and cause life threatening bleeding. Athletes with an enlarged spleen are usually kept out of contact sports for about two months and should be cleared from their medical provider before returning to sports.

When should I go to the Emergency Room for an abdominal injury?

You should go to the ER if there are any signs of more serious injury such as:

• Rapid heart rate
• Mental confusion
• Rapid breathing or trouble breathing
• Change in level of alertness
• Looking pale and sweating
• Abdominal or shoulder pain after a serious fall or blow to the abdomen
• Bruising on the abdomen or back