How do you know if you have an abdominal hematoma? Key Signs and Diagnostic Steps

September 27, 2025 •

4 min read

While uncommon, an abdominal hematoma can be a cause of acute abdominal pain, often mimicking other, more common conditions. Knowing how to differentiate the signs is critical for a timely and accurate diagnosis. Here is what to consider when asking how do you know if you have an abdominal hematoma?

Quick Summary

An abdominal hematoma is typically indicated by sudden, sharp, and localized abdominal pain that worsens with muscle tensing, potentially accompanied by a palpable, tender mass, and sometimes visible bruising (ecchymosis) that appears several days later. Because these symptoms overlap with other conditions, a definitive diagnosis requires medical evaluation, often involving imaging tests like ultrasound or CT scans to visualize the blood collection.

Key Points

Acute Abdominal Pain: An abdominal hematoma is typically characterized by sudden, sharp, and localized abdominal pain, often worsened by movements that tense the abdominal muscles.
Palpable Mass: A firm, tender, and non-pulsatile mass may be felt in the affected area of the abdominal wall, though this can be difficult to detect in all cases.
Delayed Bruising: Visible bruising, or ecchymosis, on the skin over the hematoma may not appear for several days after the initial bleeding event.
Associated Symptoms: In more severe cases, systemic signs like a drop in blood pressure, rapid heart rate, or unexplained pallor can indicate significant internal blood loss.
Diagnostic Imaging is Key: A definitive diagnosis relies on medical imaging, most commonly an ultrasound or CT scan, as symptoms alone are not sufficient to distinguish it from other abdominal conditions.
Anticoagulation Risk: Individuals on blood-thinning medication are at a significantly higher risk for developing an abdominal hematoma, sometimes with more severe outcomes.
Seek Prompt Medical Attention: Anyone suspecting an abdominal hematoma, especially with severe pain or signs of internal bleeding, should seek immediate medical evaluation.

Understanding the Symptoms of an Abdominal Hematoma

An abdominal hematoma, particularly a rectus sheath hematoma, results from bleeding within the abdominal wall muscles, often the rectus abdominis. The symptoms can vary significantly based on the size and location of the blood collection. Recognizing these signs is the first step toward getting appropriate medical attention.

Primary Pain and Tenderness

The most common and prominent symptom is acute abdominal pain. This pain is often described as:

Sudden in onset: The pain can start abruptly, sometimes following a specific action like a strong cough, sneeze, or vigorous exercise.
Sharp and severe: The intensity can be significant, leading to concern over serious internal injury.
Localized: The pain is usually confined to one area of the abdomen, most often in the lower quadrants.
Worsens with muscle contraction: Actions that tense the abdominal muscles, such as sitting up from a lying position, coughing, or straining, can dramatically increase the pain. This is known as a positive Carnett's sign.

Visible Signs and Masses

While some hematomas are too deep to be seen, others may produce visible or palpable signs.

Palpable Mass: A firm, tender, and non-pulsatile mass may be felt within the abdominal wall. This mass may become more prominent when the abdominal muscles are contracted.
Bruising (Ecchymosis): Visible bruising may appear on the skin around the abdominal area, though this can take several days to become apparent.
Signs of Internal Bleeding: In severe cases, particularly large hematomas, signs of significant blood loss can occur. These symptoms constitute a medical emergency:
- Rapid heart rate (tachycardia)
- Low blood pressure (hypotension)
- Noticeable paleness of the skin (pallor)

Causes and Risk Factors

Understanding the potential causes and risk factors is vital for anyone concerned about an abdominal hematoma. While trauma is a common cause, many cases are spontaneous, especially in at-risk individuals.

What Can Lead to an Abdominal Hematoma?

Anticoagulation Therapy: The use of blood thinners (like warfarin, heparin, or apixaban) is a major risk factor, significantly increasing the likelihood and severity of bleeding into the rectus sheath.
Increased Intra-abdominal Pressure: Strenuous activities or sudden, forceful muscle contractions can rupture blood vessels. These include:
- Violent coughing or sneezing
- Vomiting
- Straining during bowel movements or urination
- Vigorous exercise or heavy lifting
Trauma: Direct blunt trauma to the abdomen, such as from a fall or a car accident, can cause epigastric artery damage.
Surgery: Recent abdominal surgery or injection procedures carry a risk, especially if there is excessive retraction or inadequate hemostasis.
Medical Conditions: Certain systemic conditions can increase susceptibility, including chronic kidney disease, hypertension, and coagulation disorders.
Pregnancy: The physiological changes and increased pressure during pregnancy and labor can be a factor.

How an Abdominal Hematoma is Diagnosed

Because the symptoms can be non-specific and overlap with other abdominal conditions, a healthcare provider relies on a combination of physical examination, patient history, and imaging studies for a definitive diagnosis.

The Diagnostic Process

Medical History and Physical Exam: The doctor will ask about the onset of pain, any precipitating events, and other symptoms. The physical exam will check for tenderness, swelling, or a palpable mass, and may include checking for Carnett's sign.
Blood Tests: A complete blood count will be ordered to check for a drop in hemoglobin, which can indicate significant blood loss. Coagulation tests are also crucial, especially for patients on anticoagulant therapy.
Imaging Studies: Imaging is the most effective way to confirm the diagnosis and assess the hematoma's size and location.
- Ultrasound: Often the first-line imaging test, it can quickly visualize fluid collection within the abdominal wall. It's safe and widely available.
- CT Scan: Provides more detailed and specific information about the hematoma, including its size, location, and potential extension. A CT scan with contrast can even show active bleeding.

Comparison: Abdominal Hematoma vs. Other Acute Abdominal Issues

It's easy to mistake an abdominal hematoma for more common acute abdominal conditions. This table helps distinguish key differences.


Feature	Abdominal Wall Hematoma	Appendicitis	Diverticulitis
Location	Localized to abdominal wall; often lower quadrant	Right lower quadrant	Left lower quadrant
Pain Onset	Often sudden after specific action	Gradual, migrating from periumbilical area	Often gradual
Muscle Tensing	Worsens pain (Positive Carnett's Sign)	Does not worsen pain, may decrease it (Negative Carnett's Sign)	Varies, usually unrelated to tensing
Risk Factors	Anticoagulants, trauma, coughing, surgery	Common in young adults, familial predisposition	Common in older adults, low-fiber diet
Associated Symptoms	Possible ecchymosis (later), mass	Nausea, fever, loss of appetite, vomiting	Fever, nausea, changes in bowel habits
Diagnostic Confirmation	Ultrasound, CT scan	Ultrasound, CT scan, physical exam	CT scan, physical exam

What to Do If You Suspect an Abdominal Hematoma

Do Not Ignore: Severe or persistent abdominal pain should never be ignored. Delaying medical attention can lead to complications, especially if bleeding is significant.
Seek Medical Care: If you experience sudden, sharp abdominal pain, particularly after a recent injury or if you are on blood thinners, contact a healthcare provider or go to an emergency room immediately.
Provide Full History: Inform medical staff about your symptoms, any recent trauma or strenuous activity, and all medications you are taking, especially blood thinners.
Follow Treatment Plan: Treatment for most abdominal hematomas is conservative, involving rest and pain management. For larger or actively bleeding hematomas, more aggressive intervention like arterial embolization or surgery may be necessary.

Conclusion: The Importance of Professional Diagnosis

While this article provides guidance on how do you know if you have an abdominal hematoma, it is not a substitute for professional medical advice. The overlapping symptoms with other serious conditions make a definitive diagnosis based on self-assessment unreliable. Early and accurate diagnosis by a medical professional, often through imaging, is crucial for appropriate management and to prevent potentially serious complications.

For more information on the differential diagnosis of abdominal pain, you can visit the Medscape Reference for Rectus Sheath Hematoma Workup.

Frequently Asked Questions

An abdominal hematoma is a localized collection of blood outside of blood vessels that occurs within the layers of the abdominal wall muscles, most commonly the rectus sheath.

Abdominal hematomas can result from trauma, forceful muscle contractions (like severe coughing), recent surgery, or be a complication for individuals taking anticoagulant medication. Bleeding occurs when epigastric arteries or their branches rupture.

Yes, it is often possible to feel a tender, firm, and non-pulsatile mass during a physical exam. However, if the hematoma is located deep within the abdominal wall or in an obese individual, it may not be palpable.

While many abdominal hematomas are self-limiting and resolve on their own, large or expanding ones can lead to hypovolemic shock and are considered a medical emergency. Signs like a fast heart rate or low blood pressure warrant immediate medical attention.

Doctors typically use imaging tests to diagnose an abdominal hematoma. An ultrasound is often the first step, while a CT scan with contrast is more definitive and can detect active bleeding.

A positive Carnett's sign is when a patient’s abdominal tenderness is increased or remains the same when they tense their abdominal muscles. This indicates the source of the pain is in the abdominal wall, rather than inside the abdominal cavity, suggesting a hematoma.

Treatment depends on the severity. Most small hematomas are managed conservatively with bed rest and pain relief. For larger or actively bleeding hematomas, intervention such as blood transfusions, arterial embolization, or surgery may be necessary.

In many cases, small rectus sheath hematomas are self-limiting and will resolve on their own over a period of weeks to months with conservative management. Larger hematomas or those with active bleeding require close monitoring.