What are the potential causes of bloated stomach, pain and nausea. How can you tell if these symptoms indicate a serious health issue. When should you seek medical attention for persistent bloating and nausea.

Understanding Bloated Stomach: More Than Just Discomfort

A bloated stomach is a common complaint that many people experience from time to time. However, when accompanied by pain and nausea, it may signal something more serious than simple indigestion. Bloating occurs when the stomach or intestines fill with air or gas, leading to physical discomfort, abdominal pain, nausea, and decreased appetite.

While occasional bloating is usually harmless, persistent or severe symptoms shouldn’t be ignored. Let’s explore the potential causes, warning signs, and when to seek medical attention for bloated stomach pain and nausea.

Common Causes of Stomach Bloating and Nausea

There are several reasons why you might experience a bloated stomach along with nausea:

• Swallowing excess air while eating or drinking
• Consuming gas-producing foods
• Smoking or chewing gum
• Side effects of certain medications
• Gastrointestinal disorders
• Hormonal changes
• Stress and anxiety

In many cases, bloating and nausea can be managed through lifestyle changes and over-the-counter remedies. However, persistent symptoms may indicate an underlying health condition that requires medical attention.

Warning Signs: When Bloating and Nausea Become Serious

While occasional bloating is common, certain symptoms accompanying stomach bloating and nausea should not be ignored. These warning signs may indicate a more serious condition:

• Bloating that persists for more than two weeks despite medication
• Unexplained weight loss
• Pale skin
• Loss of appetite
• Yellowing of the skin (jaundice)
• Severe or persistent abdominal pain
• Blood in stool or vomit
• Fever

If you experience any of these symptoms along with bloating and nausea, it’s crucial to consult a healthcare professional promptly. These signs could potentially indicate conditions such as gastrointestinal cancers, liver disease, or other serious health issues that require immediate medical attention.

Gastrointestinal Conditions Associated with Bloating and Nausea

Persistent bloating and nausea can be symptoms of various gastrointestinal conditions, including:

• Gastritis
• Gastric ulcers
• Irritable Bowel Syndrome (IBS)
• Inflammatory Bowel Disease (IBD)
• Celiac disease
• Intestinal obstruction
• Gastroparesis

Each of these conditions has unique characteristics and may require specific treatments. For instance, gastritis involves inflammation of the stomach lining, while IBS is a functional disorder affecting the large intestine. Proper diagnosis is essential for effective management of these conditions.

Can bloating and nausea be symptoms of cancer?

In some cases, persistent bloating and nausea can be early signs of certain types of cancer, particularly those affecting the gastrointestinal system. Ovarian cancer, for example, often presents with bloating as one of its early symptoms. Pancreatic cancer and stomach cancer may also cause bloating and nausea. While these symptoms don’t necessarily mean you have cancer, it’s important to have them evaluated by a healthcare professional, especially if they persist or are accompanied by other warning signs.

The Role of Diet and Lifestyle in Managing Bloating and Nausea

Making certain dietary and lifestyle changes can often help alleviate bloating and nausea:

1. Avoid high-fat foods that are difficult to digest
2. Eat smaller, more frequent meals instead of large portions
3. Chew food thoroughly to aid digestion
4. Stay hydrated by drinking plenty of water
5. Limit consumption of gas-producing foods like beans, cabbage, and carbonated drinks
6. Incorporate regular exercise into your routine
7. Practice stress-reduction techniques such as meditation or yoga

Remember, while these strategies can be helpful, they may not address underlying health issues. If symptoms persist despite these changes, it’s important to seek medical advice.

Medical Treatments for Chronic Bloating and Nausea

When lifestyle changes aren’t enough to manage bloating and nausea, medical interventions may be necessary. Treatment options can include:

• Over-the-counter antacids or gas-relief medications
• Prescription medications to address specific gastrointestinal issues
• Probiotics to support gut health
• Antibiotics if a bacterial infection is present
• Dietary counseling with a registered dietitian
• Cognitive-behavioral therapy for stress-related symptoms

The appropriate treatment will depend on the underlying cause of your symptoms. A healthcare provider can help determine the best approach based on your individual situation.

How effective are over-the-counter remedies for bloating and nausea?

Over-the-counter remedies can be effective for mild, occasional bloating and nausea. Antacids can help neutralize stomach acid, while simethicone-based products can help break up gas bubbles in the digestive tract. Ginger supplements or tea may also help alleviate nausea. However, these remedies are not suitable for long-term use without medical supervision. If symptoms persist for more than two weeks despite using over-the-counter treatments, it’s important to consult a healthcare provider.

The Importance of Proper Diagnosis for Persistent Symptoms

While self-management strategies can be helpful for mild cases of bloating and nausea, persistent or severe symptoms require professional medical evaluation. A healthcare provider may use various diagnostic tools to determine the underlying cause of your symptoms:

• Physical examination
• Blood tests
• Stool analysis
• Imaging studies (such as X-rays or CT scans)
• Endoscopy or colonoscopy
• Breath tests for specific conditions

These diagnostic procedures can help identify or rule out serious conditions, ensuring that you receive appropriate treatment. Don’t hesitate to seek medical attention if your symptoms are severe, persistent, or accompanied by warning signs.

What are some less common causes of chronic bloating and nausea?

While gastrointestinal issues are often the primary culprits behind chronic bloating and nausea, there are some less common causes to consider:

• Endometriosis: This condition, where uterine tissue grows outside the uterus, can cause bloating and nausea, especially around menstruation.
• Thyroid disorders: Both hypothyroidism and hyperthyroidism can affect digestive function, leading to bloating and nausea.
• Diabetes: Uncontrolled diabetes can cause gastroparesis, a condition where the stomach takes too long to empty, resulting in bloating and nausea.
• Liver or gallbladder problems: Issues with these organs can interfere with digestion and cause bloating and nausea.
• Certain medications: Some medications, particularly those affecting the nervous system, can slow down digestion and cause bloating as a side effect.

These less common causes highlight the importance of a thorough medical evaluation when dealing with persistent bloating and nausea. A healthcare provider can consider these possibilities and conduct appropriate tests to determine the underlying cause of your symptoms.

Preventing Bloated Stomach Pain and Nausea

While it’s not always possible to prevent bloating and nausea entirely, there are steps you can take to reduce their frequency and severity:

1. Maintain a balanced diet rich in fiber and low in processed foods
2. Stay physically active with regular exercise
3. Manage stress through relaxation techniques or counseling
4. Avoid known trigger foods that cause digestive discomfort
5. Eat slowly and mindfully to reduce air swallowing
6. Stay hydrated but avoid drinking large amounts of fluid with meals
7. Limit alcohol and caffeine consumption
8. Quit smoking if you currently smoke

Remember that prevention strategies may need to be personalized based on your individual triggers and health conditions. Working with a healthcare provider or registered dietitian can help you develop an effective prevention plan tailored to your needs.

Can probiotics help prevent bloating and nausea?

Probiotics, which are beneficial bacteria that support gut health, may help prevent or reduce bloating and nausea in some individuals. These microorganisms can improve digestion, reduce inflammation, and help maintain a healthy balance of gut bacteria. While research on probiotics is ongoing, some studies have shown promising results for conditions like irritable bowel syndrome and antibiotic-associated diarrhea. However, the effectiveness of probiotics can vary depending on the specific strains used and the individual’s gut microbiome. It’s best to consult with a healthcare provider before starting any probiotic regimen, as they can recommend appropriate strains and dosages based on your specific health needs.

When to Seek Emergency Medical Care

While many cases of bloating and nausea can be managed at home or through routine medical care, certain situations require immediate medical attention. Seek emergency care if you experience:

• Severe, sudden abdominal pain
• Chest pain or difficulty breathing
• Persistent vomiting, especially if it contains blood
• Signs of severe dehydration (extreme thirst, dark urine, dizziness)
• High fever accompanied by abdominal pain
• Rapid heartbeat or cold, clammy skin
• Inability to pass gas or have a bowel movement, especially if accompanied by vomiting

These symptoms could indicate serious conditions such as appendicitis, intestinal obstruction, or other medical emergencies that require immediate treatment. Don’t hesitate to call emergency services or go to the nearest emergency room if you experience these symptoms.

How can you distinguish between normal bloating and a medical emergency?

Distinguishing between normal bloating and a medical emergency can be challenging, but there are some key factors to consider:

• Duration: Normal bloating typically resolves within a few hours to a day. Persistent bloating lasting more than a few days may indicate a more serious issue.
• Severity: Mild to moderate discomfort is typical of normal bloating. Severe, debilitating pain is a red flag.
• Associated symptoms: Normal bloating usually occurs in isolation or with mild discomfort. If bloating is accompanied by severe pain, fever, vomiting, or other concerning symptoms, it may signify a medical emergency.
• Pattern: Regular bloating that follows a predictable pattern (e.g., after certain meals) is less likely to be an emergency than sudden, unexplained bloating.
• Response to remedies: Normal bloating often responds to over-the-counter remedies or lifestyle changes. If these measures don’t provide relief, it could indicate a more serious condition.

When in doubt, it’s always better to err on the side of caution and seek medical advice. Trust your instincts – if something feels seriously wrong, don’t hesitate to seek emergency care.

Signs that shouldn’t be ignored

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Gastrointestinal disease

HIGHLIGHTS:

• A bloated stomach that lasts longer than 2 weeks after taking medications, weight loss, pale skin, loss of appetite and yellowing of the skin can be warning signs of cancer.
• Sitting too long without exercise can contribute to stomach bloating.

Although a bloated stomach is a common symptom that is not harmless, it can actually be a sign of something serious. A bloated stomach that lasts longer than 2 weeks after taking medications, weight loss, pale skin, loss of appetite and yellowing of the skin can be warning signs of cancer. Bloating should not be ignored.

A bloated stomach occurs when the stomach or intestine fills with air/gas, causing physical discomfort, stomach pain, nausea or poor appetite. Air or gas in the stomach is typically caused by swallowing air while eating certain types of foods, smoking and chewing gum. Some medications can cause bloating as a side effect, such as sleeping pills, sedatives and antidepressants which influence the nervous system in a way that can lessen bowel contractions, resulting in bloating.

Some people have a bloated stomach for a long period of time due to gastrointestinal tract disease, including gastritis, gastric ulcer, gastrointestinal or colorectal cancer, parasitic infection, irritable bowel syndrome, intestinal dysfunction, and other system disorders such as thyroid and diabetes, which can contribute to stomach bloating that requires detailed examinations.

Are bloated stomachs and stomach fullness the same or different?

A bloated stomach and stomach fullness are symptoms of having excessive gas in the stomach, causing discomfort, a feeling of fullness, a swollen stomach after a meal, nausea, excessive flatulence, and feeling better after belching or passing wind.

Treatment

If you have the above symptoms without warning signs, you can use carminatives or medications that help with digestion, and change dietary habits. However, if the symptoms last longer than 2 weeks after taking medications, please consult a doctor for detection of the cause of the symptoms.

Basic Self-Management

• Avoid high-fat foods that are difficult to digest.
• Do not eat a big meal.
• Chew food thoroughly.
• Sitting too long without exercise can contribute to stomach bloating. Exercise regularly.

Do not leave a “bloated stomach” untreated. Although bloating is a common symptom that is not harmless, it can actually be a sign of something serious or lead to other conditions.

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Benjarat Promjunyakul, M.D.

Gastroenterology

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Causes and what to do

If a person is bloated, nauseous, and tired, changing their eating habits may help. However, if these symptoms persist, it may be a sign of an underlying health condition.

People with a bloated stomach, nausea, and tiredness may find their stomach feels enlarged, tight, and uncomfortably full.

They may have a stomach ache or pass more gas than usual. In some cases, salty foods and carbohydrates can make someone feel sleepy or bloated.

In this article, we look at the causes of bloating, nausea, and tiredness, and what people can do to relieve these symptoms.

Share on PinterestEating habits, constipation, stress, and other medical conditions may lead to bloating, nausea, and tiredness.

There are many reasons why a person might have a bloated stomach and be feeling sick and tired. Read on for some potential causes.

Eating habits

There are several ways a person’s eating habits and diet can contribute to feeling bloated, nauseous, or tired.

These include:

• eating too quickly
• eating large portions
• drinking carbonated drinks
• eating foods high in salt
• eating a lot of carbohydrates

Eating moderate portions of food slowly and mindfully may aid digestion and ease symptoms.

Constipation

Constipation occurs when someone has less frequent bowel movements than usual. The bowel movements they do have may feel difficult, uncomfortable, or painful.

Other symptoms of constipation include:

• bloating
• feeling sluggish
• stomach pain

According to John Hopkins Medicine, constipation is the most common digestive condition in the United States.

Constipation has a range of causes, including:

• sudden changes in diet or lifestyle
• pregnancy
• dehydration
• not eating enough fiber
• medication that has constipation as a side effect

Treatment for constipation depends on the cause but often involves dietary and lifestyle changes. If these do not work, a doctor may prescribe a laxative.

Stress

Stress and anxiety can affect the nerves of the digestive system, slowing down the movements of the intestines. This may cause people to feel bloated, nauseous, and tired.

Stress can also contribute to constipation, as well as other gastrointestinal conditions.

The American Institute of Stress list a wide range of other symptoms that stress can cause, including:

• nervous habits, such as fidgeting
• muscle tension or pain
• cold or sweaty hands and feet
• insomnia or nightmares
• headaches or jaw clenching
• changes in appetite
• frequent illness, such as colds or flu

Stress can be difficult to manage. However, there are many ways someone can relieve stress, such as:

• deep breathing exercises
• yoga or meditation
• journaling
• prayer
• massage or self-massage

It is a good idea for people to experiment with different stress management techniques to find what helps.

Small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth (SIBO) occurs when too many bacteria grow in the small intestine.

SIBO can cause:

• bloating and gas
• diarrhea or constipation
• stomach pain
• nausea
• fatigue

People with SIBO often have low motility, meaning the small intestine does not push food through the digestive tract as it should.

Diverticulitis, abdominal surgery, and adhesions can also make SIBO more likely.

There are several types of SIBO, and the type someone has will determine their treatment. Doctors may prescribe an antibiotic or combination of antibiotics.

People with SIBO may feel relief from symptoms by following a low FODMAP diet.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are compounds that bacteria ferment, sometimes causing SIBO symptoms.

Learn more about the low FODMAP diet.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) describes a group of symptoms that affect the gastrointestinal tract, including:

• abdominal pain and cramping
• diarrhea or constipation
• bloating
• white mucus in stools

Because of the range of causes, treatment for IBS varies. The low FODMAP diet, reducing stress, and medications that alleviate the symptoms can help someone manage the condition.

A variety of factors can cause IBS. Stress, early life trauma, and bacterial infections may play a role. Some people with IBS also have SIBO, food intolerances, or mental health conditions.

Gastroparesis

Gastroparesis means stomach paralysis and occurs when the stomach cannot contract. This causes food to sit in the stomach, disrupting digestion.

According to the American College of Gastroenterology, gastoparesis can cause the following symptoms:

• bloating
• nausea
• feeling full quickly
• heartburn
• vomiting
• abdominal pain

Abdominal pain of gastroparesis occurs under the ribs, especially in the center of the upper abdomen.

As a result of these symptoms, a person may lose weight or not get enough nutrients, which can result in tiredness.

People often manage gastroparesis by changing their diet. Foods high in fat or fiber take longer to digest. Switching to softer foods, such as nutritional drinks, soups, and stews, can help.

Dumping syndrome

Dumping syndrome happens when food empties from the stomach too quickly.

The International Foundation Gastrointestinal Disorders state that dumping syndrome can occur after people have had surgery to remove part of the stomach. It may also occur in people with other digestive conditions.

Along with bloating, nausea, and fatigue, the symptoms of dumping syndrome include:

• abdominal cramping
• diarrhea
• vomiting
• dizziness
• cold sweats

Symptoms may appear during or straight after eating, or 1–3 hours after eating. Dietary changes can often help people to relieve symptoms.

Changes can include:

• eating smaller meals more frequently
• increasing complex carbohydrates, such as whole grains
• increasing foods high in soluble fiber, such as apples, carrots, and oats
• increasing protein

It can help to talk to a dietician so that a person with dumping syndrome can maintain their weight.

Ovarian cancer

According to the Centers for Disease Control and Prevention (CDC), persistent bloating for 2 weeks or more can be a sign of ovarian cancer in females.

People may also experience:

• unusual vaginal bleeding
• pelvic pain or pressure
• feeling full quickly while eating
• difficulty eating
• constipation or more frequent bowel movements
• more frequent urination

If people have any of these symptoms, they should see their doctor right away. A doctor can request tests to determine if these symptoms are due to cancer or another condition.

In mild or temporary cases of bloating, nausea, and tiredness, a person may find their symptoms resolve with rest, bowel movements, or passing gas.

Home remedies and lifestyle changes can also help relieve symptoms. These include:

• eating smaller meals more regularly
• eating slowly and mindfully, chewing thoroughly
• trying to reduce stress
• drinking enough water throughout the day
• reducing processed foods, which can be high in fat and salt
• stopping smoking or drinking alcohol that can cause heartburn

Depending on the underlying cause, people may find increasing or decreasing fiber intake helps ease symptoms. People can talk to a healthcare professional to work out a helpful fiber intake.

If someone has persistent symptoms of SIBO or IBS after meals, they can try the low FODMAP diet to see if it eases their symptoms.

People should see their doctor if they have experienced persistent bloating for 2 weeks or more. People should also see their doctor if they have:

• unexplained weight loss
• persistent or severe abdominal pain
• blood in their urine or stool
• changes in the color of frequency of bowel movements
• loss of appetite or feeling full quickly

Bloating, nausea, and tiredness can occur due to a wide range of causes. Temporary explanations can include eating rich or salty meals, eating too much, or short-term stress. Longer-term causes include conditions such as IBS, SIBO, and gastroparesis.

People may feel an improvement in symptoms by changing their diet, eating habits, and by reducing stress if possible. However, for persistent or severe symptoms, a person can seek help from a doctor.

Abdominal pain – find out the cause!

There can be many causes of abdominal pain and some of them can be seriously life threatening.

Therefore, do not get carried away with self-treatment – traditional medicine or over-the-counter medicines. It is necessary to consult a doctor, since only a specialist is able to determine the exact diagnosis.
From the point of view of a gastroenterologist, there are quite a few places where the source of pain can be – the stomach, pancreas, small intestine, large intestine, etc. However, abdominal pain can also be caused by muscle tissue or nerve endings, which are directly related to problem areas of the spine. Pain can also be caused by pneumonia, a heart attack, or other health problems.

Abdominal pain should be taken very seriously, as it may indicate a malfunction in the functioning of internal organs. Gastroenterologist Medicīnas centrs ARS , certified endoscopist Dr. Sabri ABDELMASI.

• Pain in the abdomen and in the left hypochondrium can cause pancreatitis – inflammation of the pancreas (quite often after parties and feasts).
• Helicobacter pylori infection, gastritis or ulcer.
• Abdominal bloating because gases build up pressure and cramps occur.
• Pain may indicate a serious problem, such as a blockage in the colon. This can be caused by some kind of neoplasm or psychological problems that inhibit bowel function.
• Very severe, attacks, pain in the right hypochondrium with severe chills and nausea to vomiting is most often associated with problems in the gallbladder.
• One of the most common causes of abdominal pain is the use of anti-inflammatory drugs. For example, a person often has a headache and therefore regularly uses painkillers. Strong painkillers are also used for injuries. For the stomach, there is no difference how medicines are taken (injected or in the form of tablets) – the irritation is the same. If special medicines that protect the digestive tract are not used to protect the mucous surface of the stomach, then it becomes inflamed and hurts. Soon, extensive inflammation occurs, damage develops on the mucous surface, there may be bleeding, an ulcer occurs. Regular use of aspirin has a very negative effect on the stomach and small intestine.

What to do?

Acute pain. If the pain in the abdomen is severe, attacks and does not go away, there is sweating, a feeling of heaviness in the heart, weakness, fever, vomiting with blood, diarrhea (several times a day) with / without blood, bleeding – then urgently required call for emergency medical attention. There is a possibility that the cause of the pain may be internal bleeding, a deep ulcer, a severe infection or poisoning, which seriously threatens human life.

Chronic pain. If the pain in the abdomen is chronic and not particularly disturbing, a consultation with a doctor is required and an in-depth examination is necessary so that there are no life-threatening risks in the development of the disease. Especially if recently there has been, for example, an incomprehensible weight loss or a variable nature of defecation (diarrhea is replaced by constipation) – this can be a serious signal that you need to check and make sure that there is no malignant neoplasm. Unfortunately, people often come to the doctor late. If something hurts in the stomach from time to time, it is better to check once than to suffer in ignorance – what is there?

Methods of examination:

• Laboratory tests of blood and urine, which reveal the presence of inflammation, infection or other pathological changes, if any.
• If gallbladder problems are suspected, ultrasonography (ultrasound) and computed tomography (CT) are needed.
• For pain and burning sensation in the stomach, pain in the upper abdomen, vomiting with blood, if an ulcer or neoplasm is suspected, gastroscopy is performed and the esophagus, stomach and duodenum (initial site) are examined. AT Medical centrs ARS this examination is carried out using a new generation of video endoscopic equipment Olympus EVIS EXERA III , which allows not only to examine the esophagus, stomach and duodenal mucosa in detail, but also to simultaneously carry out diagnostics and medical manipulations, for example, remove polyps, treat a bleeding ulcer, conduct a biopsy – take samples of mucous tissues to assess the risk of tumors, and also clarify the presence of a heliobacterial infection.
• If abdominal pain is localized in the lower part, there is a painful bowel movement with an admixture of blood, painful cramps that arose due to bloating, constipation – then a colonoscopy is necessary, which will allow a qualified assessment of the mucous membrane of the colon and rectum. This is also carried out using the latest generation video endoscopy equipment Olympus EVIS EXERA III . The procedure is painless and at the same time it is possible to carry out various diagnostic and therapeutic manipulations, for example, take a sample of mucous tissue for analysis, perform a polypectomy – remove polyps, stop bleeding, etc. To get rid of any discomfort, light, short-term anesthesia is used.

12 Possible Causes of Abdominal Pain

Abdominal pain is a common complaint and can be caused or exacerbated by many factors. We present to your attention the 12 most common reasons for this.

1. Gastroenteritis (stomach flu)

In this case, abdominal pain is usually accompanied by nausea, vomiting and loose stools. It is most commonly caused by bacteria or viruses, and symptoms usually resolve within a few days.

2. Gassing

Gas occurs when bacteria in the small intestine digest certain foods. Increased gas pressure in the intestines can cause acute pain. Gas can also cause flatulence and belching.

3. Irritable bowel syndrome (IBS)

For unknown reasons, individuals with IBS are unable to digest certain types of foods. Abdominal pain is a major symptom for many IBS patients and often resolves after a bowel movement. Other common symptoms include gas, nausea, cramps, and bloating.

4. Acid reflux

Acid reflux is a condition in which acidic stomach contents enter the esophagus. This process is almost always accompanied by burning and pain. Acid reflux also causes symptoms such as bloating or cramps.

5. Gastritis

When the lining of the stomach becomes inflamed or destroyed, pain occurs. Nausea, vomiting, gas, and bloating are other common symptoms of gastritis.

6. Constipation

When bowel problems occur, pressure on the large intestine increases, which may be accompanied by pain.

7. Gastroesophageal reflux disease (GERD)

GERD is a chronic relapsing disease caused by spontaneous, regularly repeated reflux of gastric and/or duodenal contents into the esophagus, leading to damage to the lower esophagus. GERD can cause stomach pain as well as heartburn and nausea.

8. Ulcers

Ulcers (peptic or gastric) usually cause severe and prolonged abdominal pain. The most common causes of ulcers are the bacteria H. pylori and excessive and/or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs).

9. Crohn’s disease

Crohn’s disease is characterized by inflammation of the digestive tract, leading to pain, gas, diarrhea, nausea, vomiting, and bloating. Given its chronic nature, this condition can lead to malnutrition, causing weight loss and emaciation.

10. Celiac disease

Allergy to gluten, a protein found in grain products, causes inflammation in the small intestine. This, in turn, is accompanied by pain.

11. Menstrual cramps or endometriosis

Menstruation may be accompanied by abdominal pain. Bloating, gas, cramps, and constipation can also occur during menstruation, causing discomfort. Patients with endometriosis may experience severe or chronic pain due to inflammation.

12. Urinary tract and bladder infections

Urinary tract infections are most commonly caused by bacteria. Symptoms include pain, pressure in the lower abdomen, and bloating. Most infections cause painful urination.

Unusual and more serious causes

In some cases, abdominal pain is a symptom of a serious illness that, if left untreated, can be fatal.