Treatment FAQ

what is the best natural treatment for hiatal hernia

by Zoey Turcotte Published 2 years ago Updated 2 years ago
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Other natural remedies for treating hiatal hernia
  • yoga.
  • self-massage, massaging your abdominal muscles in a downward motion while lying on your back on a flat surface.
  • consuming apple cider vinegar, cinnamon, aloe vera, slippery elm, or chamomile.
May 27, 2021

What is the fastest way to cure a hiatal hernia?

Try to:Eat several smaller meals throughout the day rather than a few large meals.Avoid foods that trigger heartburn, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.Avoid lying down after a meal or eating late in the day.Maintain a healthy weight.Stop smoking.More items...•

How can I shrink my hernia naturally?

Use natural remedies to relieve hernia symptoms. Although there is no natural cure for hernias, you can talk to your doctor about natural remedies — such as aloe vera, castor seed oil, and vegetable juice –which are sometimes used to relieve hernia symptoms because of their anti-inflammatory and soothing properties.

Can hiatus hernia heal naturally?

Symptoms can vary widely. A hiatal hernia enters the esophagus and passes its way onto the stomach. Larger hernias may require surgery, but typical hiatal hernias can heal with exercises and stretches that can strengthen the diaphragm. These exercises can reduce the risk and may even relieve some symptoms.

Does apple cider vinegar help with hiatal hernia?

Drinking a small amount of diluted apple cider vinegar at the beginning of meals may also help reduce symptoms.

How I healed my hiatal hernia?

How to heal your hiatal hernia at homelosing weight (if needed)decreasing food portion sizes.eating several smaller meals throughout the day (as opposed to a few large meals)elevating the head of your bed by 8 inches.avoiding meals 2 to 3 hours before bedtime or before lying down.More items...•

Which herb can treat hernia?

Quickest & Simplest Ways to Treat HerniaMilk with a pinch of turmeric powder.A herbal mixture including fennel, citrus seeds, and hawthorn & litchi seeds.Smaller meals at regular intervals.High water intake.High fibre, high protein, low fat diet.Fresh green vegetables.Whole wheat ingredients.More items...

Can Honey Cure hiatal hernia?

Eating honey or drinking honey water can help hiatal hernia symptoms such as inflammation.

What supplements for hiatal hernia?

6 Vitamins and Supplements for Acid RefluxBetaine HCl with pepsin. Betaine hydrochloride (HCl) is a compound used to increase stomach acid (2). ... B vitamins. Some research suggests that B vitamins, including folate, riboflavin, and vitamin B6, may help treat acid reflux. ... Melatonin. ... Iberogast. ... Probiotics. ... Ginger.

Can probiotics help a hiatal hernia?

Fermented or cultured foods that are rich in probiotics (acid-neutralizing stomach bacteria) may also help reduce hiatal hernia symptoms. It is important to note that consuming processed sugar alongside probiotics may be counterproductive.

What relaxes a hiatal hernia?

What's the best way to reduce hiatal hernia symptoms? To reduce hiatal hernia symptoms, consider over-the-counter medications such as antacids or H2 blockers. These can be used to relieve heartburn and acid reflux attacks.

What tea is good for hiatal hernia?

Research suggests that chamomile tea may help relieve acid reflux symptoms caused by inflammation or stress.

Does drinking water help hernia?

Eat high-fiber foods and drink plenty of water. This helps prevent constipation and straining during bowel movements.

How to fix a hernia without surgery?

Here’s how to fix a hiatal hernia naturally without surgery, with a quick morning exercise. (See video below.) Drink a glass of room temperature or slightly warm water when you get out of bed in the morning. (Skip the coffee, tea, juice, and cold water—just drink warm water.) While standing, bring your arms straight out from your sides ...

Why do you breathe at the end of a hiatal hernia?

The breathing at the end helps close the diaphragm and the hole where your stomach was lodged. As long as you have a hiatal hernia, this is an exercise you’ll have to do every morning to put an end to your acid reflux problems.

What happens when you have a hernia?

But first, a quick explanation of what’s happening when you have a hiatal hernia... Your diaphragm separates the organs in your chest from your stomach and other digestive organs. But in the case of a hiatal hernia, your stomach has breached the divide, worming its way through an enlarged hole at the back of the diaphragm ...

How does warm water help your stomach?

That’s it. You are essentially forcing your stomach out of the hole. The warm water acts as a weight in the stomach, while relaxing the stomach muscles as well. The breathing at the end helps close the diaphragm and the hole where your stomach was lodged.

What foods should I eat if I have a hernia?

The best foods to consume if you have a hiatal hernia include: 1 Green beans 2 Apples and bananas 3 Fat free cheese 4 Soy milk or skim milk 5 Chicken and fish 6 Water 7 Grains 8 Carrots and broccoli 9 Pretzels

What is the best treatment for a hernia?

3. Yoga: Yoga is a great natural remedy for hiatal hernias because it focuses on one’s core strength. 4. Apple cider vinegar: Because of its acidic nature, apple cider vinegar is one of the more effective natural treatments for a hiatal hernia.

How to get rid of bloating and pain in the stomach?

Mix one tablespoon of apple cider vinegar in a large glass of lukewarm water and drink it before a meal. 5. Cinnamon: Cinnamon is a natural antacid that can help relieve abdominal pain and bloating. Adding half a teaspoon of powdered cinnamon to a cup of hot water should be effective. Drink the mixture twice a day.

How to treat a hernia in the stomach?

Some of the more popular remedies include: 1. Water: Drinking water first thing in the morning has been proven to reduce the symptoms of a hiatal hernia. A lukewarm glass of water before you get out of bed will add weight to your stomach, helping it to relax.

How to get rid of a swollen toe?

Try standing up, with your arms extended straight out to your sides. With your arms still extended, leave your mouth open and take short breaths for about 15 seconds. Next, bend your arms simultaneously until they touch your chest. You can also perform several toe lifts immediately after the first exercise.

Can a large hernia cause chest pain?

A small hiatal hernia might not result in any symptoms, but a large hiatal hernia can cause adverse symptoms like chest pain, abdominal pain, heartburn, and fatigue. There’s also a connection between a hiatal hernia and GERD —a hiatal hernia can actually provoke the symptoms of GERD because the protruding stomach makes it easier for digested food ...

Can you eat bland food with a hernia?

A hiatal hernia can sometimes result in pain and discomfort, but changing your diet can make a difference. The food you eat doesn’t necessarily have to be completely bland or tasteless , but you should definitely avoid certain types of food that incites unpleasant symptoms.

How to manage a hiatal hernia?

Sleep Positioning: Perhaps one of the easiest and most effective forms of managing a hiatal hernia is simply sleeping the right way. There are devices sold for this purpose, often wedge shaped, to keep an upright position during sleeping.

What to eat if you have a hernia?

5. Eating Cinnamon:A diet tailored for people with a hiatal hernia typically involves using less spice and seasoning, however cinnamon might be the exception to the rule. While it should be enjoyed in moderation, the sweet spice can contribute to better digestion and has been used as an aid in this regard for centuries.

What teas can help with hernia pain?

However, there are some herbsfor hiatal hernia relief that can be brewed into delightful teas that might be beneficial. For instance, slippery elm makes a fabulous tea that can promote healthy mucus coatings, and chamomile is an herb that has long been associated with reducing painful inflammation.

What essential oils are good for a hernia?

Other popular essential oils include ginger, coriander and anise. 7.

What are the best options for a hernia?

Options for managing the condition include choices in hiatal hernia natural treatment, medications and lifestyle changes. Diet is one of the best options in. Options for managing the condition include choices in hiatal hernia natural treatment, medications and lifestyle changes. Diet is one of the best options in. Hiatal Hernia Condition.

Can hiatal hernia be genetic?

For any treatment to be effective however, the underlying causes of the symptoms should be considered. In most cases, the causes of hiatal hernia are unknown. They may be genetic or could be brought about by something as innocuous as a particularly strenuous bowel movement.

Is hiatal hernia asymptomatic?

For many people, the condition can be completely asymptomatic. For others, pain and discomfort often attributed to heartburn and other acid related conditions can present. Options for managing the condition include choices in hiatal hernia natural treatment, medications and lifestyle changes. Diet is one of the best options in a treatment ...

How to diagnose a hiatal hernia?

If you do have symptoms, your doctor can diagnose a hiatal hernia by performing an endoscopy test, a pH test, barium swallow scans or X-rays to look for abnormalities inside the eso phagus.

Where do hiatus hernias form?

A hiatal hernia, also known as a hiatus hernia, forms inside the diaphragm, the muscular area that lays between the chest and the lower abdomen.

How to get rid of GERD symptoms?

Being overweight or obese puts extra pressure on the valves and sphincter that allow release of stomach acid. In addition, obesity is often associated with low levels of stomach acid. ( 10 ) In eight of nine studies included in a large review, as BMI (body mass index, a measure of body fat ) rose, so did GERD symptoms. Try to reach and remain at a healthy weight. Eat an unprocessed diet, get more exercise and manage other unhealthy habits.

What percentage of people have a hernia?

It’s the most common diaphragmatic hernia, with the prevalence rate of hiatal hernia is between 13 percent to 60 percent of all adults. This includes roughly half of those over the age of 50. However, many people with a hiatal hernia have no idea because they never experience noticeable symptoms. The abdomen holds most of ...

Which type of hernia is riskier?

Of the two types, paraesophageal her nia is riskier because it can lead to reduced blood flow reaching the stomach, contributing to complications like cell death and tissue damage. Type III hiatal hernia: This type is a mixture of type I and II hiatal hernia because it involves both defects.

How to get rid of stomach pain after eating?

Try not to head to bed for several hours after eating dinner, since lying down can make symptoms worse. Relax after your last meal of the day, stay upright for 3 hours and try to avoid being completely stationary. For help with controlling flow of stomach contents, adjust your sleeping position. Sleep on a slight angle and raise the head of your bed 6 to 8 inches. You can do this by using a bigger pillow by placing lifters or blocks under your bedposts. Struggle to get good sleep many nights in general? Try exercising more during the day. Exercise may help you fall asleep more soundly and also has many benefits for digestive health including lowering inflammation.

Can a hernia cause heartburn?

While many people with hiatal hernia suffer from symptoms of heartburn/acid reflux, the hernia doesn’t seem to directly cause these conditions. Instead, whatever factors contribute to acid reflux (poor diet, inflammation, etc.) also contribute to hernias. Having a hiatal hernia isn’t a guarantee of developing acid reflux or GERD.

How to cure a hiatal hernia?

Maintaining a healthy weight can also serve as one of the most effective home remedies for hiatal hernia. Obesity or carrying extra weight places extra pressure on the valves and sphincter which release stomach acid. Your body mass index (BMI) is in direct relationship to digestive issues.

What is the best natural remedy for a hernia?

Aloe Vera. You are probably already aware of the soothing effects of Aloe Vera for wounds, bites and stings. You can get that same soothing relief when you make use of it as one of the home remedies for hiatal hernia. Aloe Vera lines and soothes the inner lining of your digestive tract to reduce burning and pain.

How to cure a hernia?

Mix 1 to 2 tsp of raw, unfiltered apple cider vinegar in a glass of warm water. Sip this solution before meals. Repeat this daily for a week or so. 3. Chamomile. You can also get relief from another of the best home remedies for hiatal hernia, which includes Chamomile tea.

How to heal a hernia in the diaphragm?

1. Warm Water. One of the simplest and most effective home remedies for hiatal hernia involves drinking warm water and performing a particular series of exercises to help move the hernia from the opening of the diaphragm. What to Do.

What is the best medicine for a hernia?

Cinnamon. Cinnamon is also among the simplest home remedies for hiatal hernia. This common spice helps to calm and soothe your stomach, especially when you are experiencing bloating or abdominal pain after eating a meal. It also works as an antacid.

Can smoking cigarettes cause a hernia?

If you are a smoker and have hiatal hernia issues, first among the home remedies for hiatal hernia that you need to consider is to quit smoking. Smoking cigarettes not only impairs the muscle reflexes responsible for controlling digestive acid, but it also increases inflammation in the area and contributes to a higher acid level than is necessary for digestion.

Can a hernia prevent you from enjoying life?

There is no point in allowing hiatal hernia to prevent you from enjoying the lifestyle you enjoy or disrupting your daily routine. Make use of one or several of our 15 home remedies for hiatal hernia and take back control of your lifestyle and routine.

What is the best herb to use for hernias?

5. Black pepper. Black pepper is more than just an added flavor. It stimulates healing in those parts of the body which have been compromised when the organ began to push through the cavity wall. It can also suppress acid reflux which can help to cure the swollen region of a hernia. 6.

How to heal a hernia?

Go for brisk walks for at least 30 mins every day. 10. Vegetable juice. One of the most effective natural remedies is a glass of vegetable juice – carrot, spinach, onions, broccoli, and kale. The nutrients and anti-inflammatory nature of vegetables help to soothe the burning and painful symptoms caused due to hernia.

How to get rid of a hernia in stomach?

Consume concentrated ginger juice or raw ginger to sort relief from the pain and discomfort in your stomach. It boosts your health system at the same time. It restricts the stomach from producing gastric juices which generally occurs during hiatal hernia.

What is the best treatment for a hernia?

If someone is diagnosed with a hernia, following natural remedies can help in getting relief from the symptoms of hernia: 1. Castor seed oil. This particular oil addresses stomach problems. Castor oil helps to inhibit inflammation inside the stomach and promote proper digestion.

What is a hernia in the abdomen?

A hernia is defined as a bulging organ or fatty tissue through a soft or weak spot in the abdomen. Some facts about hernia which you must know. A hernia doesn’t cause any signs and symptoms initially. With time, the individual is likely to experience nausea, chest pain, unable to swallow food, acid reflux, etc.

How to diagnose a hernia?

Doctors diagnose a hernia simply by feeling or looking at the bulge in the affected area. After a hernia is diagnosed, medical attention is always advised. Fortunately, there are several natural remedies as well as some lifestyle changes that can provide relief from symptoms of hernia without any surgery.

How to reduce the risk of developing a hernia?

Moreover, to lower the risk of developing a hernia, you can consume this juice before every meal. 3. Ice packs. When you suffer from a hernia, there can be inflammation and pain in the abdomen. Ice packs trigger contraction when applied to the affected area and reduce inflammation inside the body.

What doctor can diagnose a hiatal hernia?

If you've been diagnosed with a hiatal hernia and your problems persist after you make lifestyle changes and start medication, you might be referred to a doctor who specializes in digestive diseases (gastroenterologist).

How to avoid heartburn?

Avoid foods that trigger heartburn, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine. Avoid lying down after a meal or eating late in the day. Maintain a healthy weight. Stop smoking.

What is the best medicine for esophageal cancer?

Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal.

Do you need surgery for a hernia?

Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.

How common is hiatal hernia?

According to the Esophageal Cancer Awareness Association (ECAA), hiatal hernias are quite common, occurring in up to 60 percent of people by the time they are 60 years old. They also note that it’s unusual for serious conditions to develop from this type of hernia.

What is the procedure for a hernia?

pantoprazole (Protonix) ra beprazole (Aciphex) Surgery for hiatal hernias typically involves three steps. The surgeon: moves the hiatal hernia from your chest cavity back into your abdomen. repairs the valve in your esophagus where your esophagus joins your stomach. tightens the hole (hiatus) in your diaphragm.

How do you know if you have a hernia?

If you have a hiatal hernia, be aware of symptoms that may indicate blood flow to your stomach has been blocked by an obstruction or a strangulated hernia. Call your doctor immediately if you: can’t pass gas or empty your bowels. feel nauseated. experience vomiting.

What is the best medicine for a swollen abdomen?

taking over-the-counter (OTC) medications such as antacids, such as Gaviscon (aluminum with magnesium hydroxide) or H-blockers (such as Pepcid AC or famotidine) avoiding tight clothing that can increase the pressure on your abdomen, such as a tight belt, control top hosiery, and body shapers.

How to get rid of a swollen head?

losing weight (if needed) decreasing food portion sizes. eating several smaller meals throughout the day ( as opposed to a few large meals) elevating the head of your bed by 8 inches. avoiding meals 2 to 3 hours before bedtime or before lying down.

Can overweight people get hiatus hernia?

Pandolfino, MD stated that, “Obese people are certainly more prone to the development of hiatus hernia.”. This leads to the conclusion that, if you are overweight, reducing your weight could lower your chances of experiencing a hiatal hernia.

Can a 50 year old get a hernia?

Hiatal hernias are quite common, especially in adults who are 50 + years old. Fortunately, it’s unusual for serious conditions to develop from them. While there are lifestyle changes you can make to treat hiatal hernia, consider discussing those changes with your doctor before moving ahead with them.

How do you treat a hernia?

Hiatal hernias are treated with lifestyle changes and medication or surgery. Specific treatment for a hiatal hernia will be determined by your doctor based on multiple factors, including your general health, anatomy, extent and location of the hernia, and severity of symptoms such as acid reflux.

How to identify a hiatal hernia?

To identify a hiatal hernia, a health care provider may use multiple diagnostic techniques but will begin with a medical history and physical examination. The provider will inquire about and/or look for: Acid reflux. Acidic or “sour” taste in the back of the mouth or throat. Anemia.

What is the name of the hernia that slides up into the chest?

Type II, III and IV hiatal hernias are called paraesophageal hernias.

What is a hernia in the abdomen?

What is a hiatal hernia? Unlike ventral hernias, which protrude through the abdominal wall, a hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest.

What happens when you have a hernia in your stomach?

A hiatal hernia results in retention of acid and other contents since the stomach tends to get sque ezed by this opening in the diaphragm. These acids and other substances can easily back up — reflux or regurgitate — into the esophagus. There are four types of hiatal hernias.

Can a hernia be controlled?

Many people do not experience any symptoms related to their hiatal hernia, or their symptoms, like heartburn, are mild. Generally, the symptoms of hiatal hernias can be controlled with lifestyle changes and medication such as:

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Overview

  • Hiatal hernia (also called hiatus hernia and paraesophageal hernia) occurs when part of the stomach protrudes into the thoracic cavity through the esophageal hiatus of the diaphragm. Embryologic development of the diaphragm is a complex process; a number of defects result in a variety of possible congenital hernias through the diaphragm. A hernia may occur through a con…
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  • A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm).Your diaphragm has a small opening (hiatus) through which your food tube (esophagus) passes before connecting to your stomach. In a hiatal hernia, the stomach pushes up through that opening and into your chest.A small hiatal hernia us…
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Treatment

  • Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.
See more on mayoclinic.org
  • If your hernia is causing no problems, it may not need treatment at all. If it is symptomatic, your doctor may recommend the same medications used for GERD: over-the-counter antacids, such as Tums and Rolaids; H2 blockers, such as Pepcid; and proton pump inhibitors (PPIs), such as Prilosec. H2 blockers and PPIs reduce the production of stomach acid, and can help the esopha…
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Signs And Symptoms

  • Most hiatal hernias are asymptomatic meaning that there are no signs and symptoms. In fact hiatal hernias are often discovered incidentally during certain diagnostic investigations despite a person not having experienced any symptoms. However, some hiatal hernias may present with the following signs and symptoms. It is important to note the signs and symptoms of a hiatal he…
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  • A hiatal hernia may cause no symptoms at allin fact, most hiatal hernias are found incidentally, during diagnostic tests for other conditions. If hiatal hernia pain occurs, they are typically mild. The most common symptom is heartburn: a burning sensation felt in the chest area. Normally, the lower esophageal sphincter (LES)the valve that prevents stomach acid from entering the esopha…
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  • Most hiatal hernias are found incidentally, and they are usually discovered on routine chest radiographs or computed tomography (CT) scans performed for unrelated symptoms. When symptomatic, patients may experience heartburn, dyspepsia, or epigastric pain. Rarely, the patient may present with recurrent chest infections resulting from aspiration of gastric contents. A para…
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  • Most small hiatal hernias cause no signs or symptoms. But larger hiatal hernias can cause: 1. Heartburn 2. Regurgitation of food or liquids into the mouth 3. Backflow of stomach acid into the esophagus (acid reflux) 4. Difficulty swallowing 5. Chest or abdominal pain 6. Shortness of breath 7. Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding...
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Diagnosis

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A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. These tests or procedures include: 1. X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coati…
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  • The diagnostic pathway for sliding hiatal hernias overlaps with that of gastroesophageal reflux disease (GERD) [Figure 1]. Diagnosis of hiatal hernias is described in this document. Diagnosis of GERD has been described in a previous SAGES publication20.Figure 1: Diagnostic pathway for GERD and for hiatal herniaPlain chest radiographs may identify soft tissue opacity with or witho…
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  • Plain chest radiographs may demonstrate a retrocardiac gas-filled structure. An upper GI barium series is the preferred examination in the investigation of suggested hiatal hernia and its sequelae. CT scans are useful when more precise cross-sectional anatomic localization is desired. The use of magnetic resonance imaging (MRI) and radionuclide studies is anecdotal. Ul…
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  • 1. Other causes of reflux 2. Rumination syndrome - self-induced regurgitation from the stomach to the mouth, caused by a voluntary rise in intra-abdominal and intragastric pressure, leading to the reflux of the gastric content into the oesophagus. 3. Other causes of chest pain. 4. More sinister causes or complications of GORD, such as Barrett's oesophagus and malignancy of the stomac…
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Causes

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When you have a hiatal hernia, it is easier for stomach acids to come up into the esophagus, the tube that carries food from your throat to your stomach. This causes a burning feeling in your throat and chest. Certain foods can make these symptoms worse for some people. Fortunately, heartburn symptoms associated …
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  • It can occur even when a person is upright but is more likely to occur when bending over or lying flat, especially after eating. Regurgitation is also more likely to occur after larger meals and is usually accompanied by heartburn.
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  • Aging puts you at risk for more health issues, particularly if youre overweight or obese. One such issue that has become more common as the U.S. obesity rate increases is hiatal hernia painestimates suggest that up to half of adults age 60 and older have this type of hernia. A hernia occurs if an organ pushes through a weakened area of the body cavity that normally contains it. …
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  • A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It's not always clear why this happens. But a hiatal hernia might be caused by: 1. Age-related changes in your diaphragm 2. Injury to the area, for example, after trauma or certain types of surgery 3. Being born with an unusually large hiatus 4. Persistent and intense pressure …
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Management

  • 1. Hiatal hernia can be diagnosed by various modalities. Only investigations which will alter the clinical management of the patient should be performed (+++, strong)
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  • Treatment is not needed in the absence of symptoms, other than in para-oesophageal hiatus hernias where the potential risks are greater and surgery may be considered even in the absence of symptoms.
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Diet

  • You may find that some of the foods listed under \"foods to avoid\" may not bother you, while others on the \"foods to enjoy\" list may cause discomfort. Everyone tolerates food differently. To determine the best diet for you, keep a food diary for a few weeks. And then avoid anything that causes you to have symptoms.
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Types

  • There are many different types of stomach conditions. From acid irritation to ulcers and even cancer, these stomach problems involve some type of disturbance or disorder of the stomach wall. A lesser known condition is a hiatal hernia. It can affect even a healthy stomach. The problem in a hiatal hernia is that a portion of the stomach becomes trapped or pinched in an ope…
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Function

  • The diaphragm ensures that abdominal organs cannot enter the chest cavity. It serves as a border and barrier but certain structures do not to pass through across the chest and abdominal cavities. The esophagus is one such example. Large blood vessels like the aorta and vena cava also need to pass between the chest and abdominal cavities.
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Risks

  • The following foods are highly acidic or may weaken the lower esophageal sphincter, making it easier for stomach acids to back up into your esophagus. They may cause heartburn symptoms. The following foods are low-acid-producing foods and are less likely to aggravate your hiatal hernia symptoms:
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