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Could I be pregnant even after 3 negative hpt? Now its your turn to let us know your symptoms or questions. Cramping may occur. Ash Some pain, cramping, and discomfort during menstrual periods is normal. The material on this website is written by Dr. Dunn A. By sundaymorning I used 1 tampon which by lunch time Sunday needed to be changed And after that Ive had nothing. Reply, This is not a oh here are my symptoms, please tell me Im pregnant comment like most others on here.? Not due on for another 2weeks today. Fever. (After 7 days, if period is missed), Joan If you experience belly pain with a clear jelly like discharge, it could be due to pregnancy. Premenstrual syndrome (PMS) encompasses the most. The diagnostic process usually begins with the doctor asking about the persons current symptoms, medical history, and family history. Crohns disease can affect any part of the GI tract. Pregnant or ovulation? Abdominal cramps and discharge can occur for many reasons, including menstruation. A discharge of mucus can be a sign of anal cancer. The secretions may also vary between thick and thi Thanks, Dr. Dunn A. I am almost 45 yrs old. If you have passed date for your next period with clear discharge, then youre likely pregnant. I have clear jelly like discharge,but it smells bad and is very uncomfortable.what should I do? No breast tenderness, no other signs. Read more about BV. Discharge that occurs with hemorrhoids may resolve without treatment, but discharge and leakage can be a sign of more serious problems, such as a rectal prolapse or cancer. This happens just before your period, and it is due to hormone changes in your body. Its possible you are pregnant, though, it could be signs your period is aproaching. They include Crohns disease and ulcerative colitis. If not treated early can cause infertility and threatened abortion. However, a watery discharge can happen for other reasons. This is necessary to make the vaginal area watery to assist the sperm in moving up to the fallopian tube. Read more about seeking treatment for PID. Our difference probably is that I have irregular period, but Ovia (this app Im using) says for this cycle I should have had my period three days ago. But this wetness before my period arrives is something new; Im usually dry a week before expected period begins. June 10, 2018 at 10:40 am Possible causes include diarrhea, nerve damage, and hemorrhoids. For these, please consult a doctor (virtually or in person). A, Abby Shirk I had intercourse with husband every day of ovulation, since then i hace been dizzy sometine stabbing pain in vagina area lower abdominal and lower back pain off and on every otger day. Best to you!! I do have PCOS and I am a little overweight. It varies in response to hormones produced as part of the female menstrual cycle. Find time to let your doctor know. Can I still be pregnant? Many conditions that cause vaginal discharge can be associated with lower abdominal or pelvic pain, which can sometimes be experienced as stomach cramps. It does not have any odor or vaginal itch. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. The pain would vary from a 1-10. Am I having my periods again? If the cause is hemorrhoids, it may go away without treatment or with OTC remedies. : Are you gonna need to rephrase this and be more specific as to where the discharge is coming from. Hi Doctor. I've been having clear watery odorless discharge and stomach ache/cramps for the past few days. The good news is that BV can be treated and cured with the use of metronidazole. Bonus Tip: You may be pregnant without knowing. and i feel tired and the back of my shoulders hurt. Having cramps with no period and white discharge may indicate pregnancy. BV occurs in women due to normal vaginal flora disruption. With lots of crap online, I Hope to quickly give reliable information about health. February 2, 2018 at 3:07 am Reply. If you are unsure of your pregnancy symptoms, you should inform your doctor. Reply. Before and during ovulation, a gelatinous discharge may occur and its due to changes in your body hormones. They may also follow up with a physical exam. It is thicker at the early and last parts of your menstrual cycle. Reply. However, if you have been noticing a change in your discharge color with pain and smell, its likely because there is a problem down there. should it have been drained? I have had four pregnancies in the past 17 years all of which were successful. (2018). December 5, 2017 at 9:40 pm Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Reply. Reply. Its normal to get worried about any change in your vaginal color. how to proceed? Also, doctors can surgically remove hemorrhoids using one of the following techniques: The following medications can relieve IBD symptoms by either suppressing an overactive immune system or reducing inflammation: Some people with IBD may require surgery to remove damaged tissue in the GI tract. pH balance pills and probiotics may help balance your vagina's natural pH level. Learn more here. Without penetration, even unprotected sex is not highly likely to result in pregnancy - but, it was close to your likely ovulation time and thus, poss No, that is not a typical sign of liver dysfunction. So, if you eventually miss your period, take a test to confirm pregnancy. However, it could be due to cancer or a sign of ectopic pregnancy. The following conditions can lead to rectal discharge: Hemorrhoids, also known as piles, are swollen veins in or around the rectum or anus. We avoid using tertiary references. Is thick clear jelly like discharge normal? How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, National Institute of Diabetes and Digestive and Kidney Diseases, https://www.ncbi.nlm.nih.gov/books/NBK557517/, https://www.ncbi.nlm.nih.gov/books/NBK537182/, https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/all-content, https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/all-content, https://www.ncbi.nlm.nih.gov/books/NBK500009/, https://www.ncbi.nlm.nih.gov/books/NBK493202/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315650/, https://www.ncbi.nlm.nih.gov/books/NBK470312/, https://www.ncbi.nlm.nih.gov/books/NBK430892/, https://www.ncbi.nlm.nih.gov/books/NBK534810/, https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis/all-content, https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract/rectal-prolapse, https://www.ncbi.nlm.nih.gov/books/NBK459167/, https://www.nhs.uk/conditions/anal-cancer/symptoms/, https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis. Please I wanted to know if it was a sign of pregnancy. Possible reasons for rectal discharge or leakage of stool include an infection, cancer, rectal prolapse, an abscess, a fistula, or hemorroids. always using a condom during sexual intercourse, refraining from douching, which can irritate the vaginal tissues, wiping from front to back after going to the bathroom. Menstruation occurs when the uterus sheds its lining once a month. PLEASE HELP ME. Your doctor will decide how to treat HPV or cervical cancer based on the severity of the condition. If you feel this way, its a sign you are fertile and in your ovulation period. Bacterial vaginosis (BV) is an infection in the vagina caused by bacteria. What causes clear jelly discharge and abdominal pain? Reply. Read more about. This may be due to implantation bleeding. Terms and Conditions Thank you. Can diet help improve depression symptoms? Clear vaginal discharge that has no smell or odor is not due to an infection. But yesterday was weird and im unsure if its just estrogen surge. Endometriosis happens when tissue similar to that of the uterus grows outside the uterus. However, you should take a pregnancy test to determine if you are pregnant. After ovulation, your basal body temperature will show a consistently higher temperature slightly above temperature levels before ovulation. When you experience these types of symptoms, there are certain things you should watch for that indicate you should schedule a visit with your doctor to be evaluated. Reply. Within a few days before ovulation, which occurs about a week afterthe end of your period, a jelly discharge with no smell or odor is normal, and you should not worry about it. If you are not sure about your discharge, you can dip your fingers in your vaginal area and examine it. A doctor can diagnose and treat the underlying causes of rectal discharge with lifestyle and diet recommendations, medication, and surgery. Or antibiotic is playing a trick on me?? Ive been doing ovulation tests and they have all been negative yet I should of just ovulated due to the calculations. It can affect the uterus, fallopian tubes, and ovaries and is a complication of chlamydia, gonorrhea, and some infections that are not STIs. Some breast tenderness with menses is not uncommon in many people. This article looks at some common causes of abdominal cramps and vaginal discharge. Reply. Hello, I have. Reply. Clear discharge is normal in women. However, it most often develops in the small intestine. Blood and Mucus delayed period and brown vaginal . Abdominal pain (stomach pain), short term. For example, certain sexually transmitted diseases, particularly gonorrhea, can cause a change in vaginal discharge and may progress to cause pain and cramps in the abdominal area 12. Reply. About Medplux Conditions that cause lower back pain and vaginal discharge include: 1. Possibly pregnancy, but taking a test is the only way to be sure. Some of the most common causes include: Abdominal cramps are common before and during a monthly period. In some instances, your doctor may recommend surgery, radiation, or chemotherapy. You need to treat your digestive symptoms . However, any change in color with smell, odor, pain while urinating or during intercourseis abnormal. External hemorrhoids develop under the skin surrounding the anus. Well recently I had some light spotting for about a week but no heavy period. Reply. Last month I was 5 days late starting but had the cramps those days. Normally, discharge is clear or whitish or yellowish. can i take painkiller for this? Stomach Cramps And Vaginal Discharge. Kayley Typically, clear, stretchy and jelly-like vaginal discharge that has the consistency of egg whites, means that you are making a lot of estrogen. She received a Bachelor of Arts in journalism from Eastern Illinois University and is now studying for a Master of Science in medicine degree to become a physician's assistant. feel abdominal pain / diarrhea. May 24, 2018 at 11:33 pm This acidic pH is needed to keep the vaginal area safe from infection. Reply. Just had my period but my breast hurt and r heavy, a lot of discharge its crystal clear sometimes yellowish never had sex .lower abdomen pain .plz help? Clear jelly discharge and abdominal pain A 28-year-old female asked: What causes a clear slimy mucus non smelling discharged along with "plug" and lower abdomen pain? November 14, 2017 at 7:29 pm Some causes may need prompt medical intervention. Lots of watery discharge from the vaginal area, before youre expecting your period, is a pregnancy sign. male 34 been having right upper abdominal pain so i drink 2.5 liters of water, eat alot of veggies and fruits and oatmeal a day. Could I be pregnant? Saw your post and it describes me all the way to the antibiotics.. did you get your Period? My third month of ttc. Elizabeth Rajan, M.D. My last period was on mothersday may 13. Just before your ovulation, there is an increase in the level of estrogen. First, its important you ensure your hands are clean. Privacy Policy Last updated on April 30th, 2019 at 02:17 pm. I have taken 3 pregnancy tests one was negative, one a line came up but only hours after (evap line Im sure) and then this morning I took another test that was so faint I discarded it but this afternoon it was a strong blue line. If you are experiencing serious medical symptoms, seek emergency treatment immediately. could you tell me if its something i need to worry about? Our website services, content, and products are for informational purposes only. What causes mucus in stools, and is it an urgent health concern? Discharge with thrush may also be thick and white, and it can have a yeasty smell. However, yellow discharge is mostlydue to an infection. I have had the terrible cramps but no bleeding, instead I have only had water discharge. So take one!!! Im too stressed out because Im not planting for one now. Reply, Oh yes, its possible you are pregnant, Christy. I also got my period last month. A vaginal yeast infection is common and has several causes, but treatment is typically simple. We look at 11 causes, along with the treatment options for each one. Hi It started maybe 5 months ago and no pain but I have had intestinal stomach problems (I thought just needed to stay away from milk and bread), Ashley We avoid using tertiary references. Save my name, email, and website in this browser for the next time I comment. About Medplux Metronidazole vaginal gel 1.3% in the treatment of bacterial vaginosis: a dose-ranging study. Reply. Cardiovascular health: Insomnia linked to greater risk of heart attack. Throwing up. Its very common. Some other common symptoms of hemorrhoids include: Hemorrhoids are relatively common causes of rectal discharge. Treatment of abdominal cramps and vaginal discharge depends on the underlying cause: Over-the-counter (OTC) pain medications and heat pads can help relieve discomfort due to abdominal cramps associated with menstruation. Clear stretchy discharge in early pregnancy is normal and does not require any treatment. Ive done 3 pregnancy tests and they were negative. Lower abdominal pain is pain that occurs at or below the belly button. The thing is I constantly feel wet but when I wipe there is nothing much. If you have unusual vaginal discharge, check in with . Just days before your period, you will feel dryness at your vaginal area as your hormones (mainly progesterone) become depleted. Seek medical attention if you think you need urgent care. September 12, 2017 at 8:21 am June 24, 2018 at 10:52 pm Abdominal cramps and vaginal discharge can happen for many reasons, including menstruation, endometriosis, and bacterial vaginosis (BV). had another ct and they're still there,my doctors says theirs not explanation because ct is clear besides that. It sounds like you may have an. A discharge of mucus can be a sign of anal cancer. Also, your birth control pill (COC pill) can cause yeast discharge, especially high dose estrogen pills. If you're experiencing ligament pain, it can be eased with regular stretching . Im 2month late of my period Am 26 years old and also marriedmy last period date is august 25thI have little bit of watery discharge daily.and also very much of knee paintirednessabdominal paini buy a pregnency testing kit and tested itresult is negativewhy i have this symptoms please help me? However, if your discharge is heavy, clear and watery just before your period, it may be a sign that youre pregnant. No smell and no itchiness. Take a test when possible. city of gary streets and sanitation; velma kelly monologue; wellington towers brantford; 0. clear jelly discharge and abdominal pain. Here, learn how to manage them and when to see a, Various factors affect the color of vaginal discharge. Some sexually transmitted infections (STIs) can cause a discharge, possibly with cramps. Avoiding foods that make you 'gassy'. It occurs during ovulation or after sexual intercourse. Are you gonna need to rephrase this and be more specific as to where the discharge is coming from. August 29, 2017 at 7:28 pm (M.B.B.S) - Written or Reviewed on December 21st, 2016 in, yellow discharge is mostlydue to an infection, How to know when Im Ovulating: 5 MAIN Signs, abnormal green vaginal discharge with itching. Acute cases of inflammation may require more direct treatments. Belly pain. Signs and symptoms of cervical cancer. If you are concerned about your discharge, this guide will help understand what clear discharge means. Ok Im getting very worried! Reply, Okay never experienced this in my lifelast month my period was weird but last about maybe 3 daysThis month I have spotted about 3 times and it is light pink and only there when I go the bathroom and only last maybe 30 min..well I had a little mild cramping yesterdaywent to the bathroom and there was the light pink spotting which was 4 days before my periodnow today is still mild cramping..but This time I had this thin wetish milky white dischargeand its now 3 days before my periodI have been very regular the last 6 years..never experienced anything like this, Yong April 29, 2018 at 7:15 pm Since i am 1 day late with clear discharge that i never had before am i pregnant, and when should i test again to see if i get a positive?? He has done over 100 c-section and supervised the delivery of over 300 babies. Tiffany Could I be pregnant? First, any change in your normal vaginal discharge warrants a doctor's visit to make sure you do not have an infection that requires treatment 1. Reply. Jan 25th, 31st, 1st, have been postive, so question is could I be pregnant? Thank u! Reply. Now it is February 2018 and have not had a regular period since end of February 2017. What is the normal discharge experienced by women? People may want to consider seeking medical attention for GI symptoms that persist for longer than a week despite trying at-home treatments. Dr. Akatakpo Dunn is a senior medical officer at the Presbyterian Joint hospital. Took pt but they all where negative. The most common STI-related cause of rectal discharge is gonorrhea. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. The period stopped around midnight and was just stain. One such symptom is clear jelly discharge. Discover ways to manage your symptoms of bacterial vaginosis (BV) with medications, antibiotics, and home treatments. What could possibly be going on, sara barker This type of discharge often occurs in the middle between your cycles and is a sign of ovulating (your body is releasing an egg) and you are fertile (able to become pregnant). Last updated on April 30th, 2019 at 02:44 pm. Vaginal douching is one of the causes of bacterial vaginosis among young women. Gas, bloating, or constipation can lead to abdominal cramps during pregnancy. It varies in response to hormones the body produces as part of the menstrual cycle. And you should always be medically evaluated if you develop these symptoms while you are pregnant. courtney nichole biography; st andrew the apostle catholic church, chandler, az; Menu. How can you tell if you have hemorrhoids or cancer? A common reason is that ligaments in the abdomen are stretching to support the growth of a fetus. If your discharge is clear and smelly, it may be due to an infection. Rectal discharge is usually a sign of an underlying problem. This article will cover rectal discharge in more detail, including its causes, other symptoms, and treatments. I had clear watery discharge 10 days ago for 2 days and again today on 24th November. My tubes are tied so im good. February 4, 2018 at 6:00 pm What is the latest research on the form of cancer Jimmy Carter has? Next, bring out your examining finger and observe the type of discharge. An abscess due to infection or an anal fistula - a channel that can develop between the end of your bowel and anus after an abscess. Pelvic inflammatory disease (PID). Im worried as my last period was January 7, normal cycle is 28 days and regular. Read more about HPV risks. Wash your hands with soap and water. Paladine HL, Desai UA. Nomsa Yeah, its very likely you are. Can i be pregnant? In some women, you may still feel your cervix, but it is soft and located high in your vaginal canal. 2016;7:1936. doi:10.3389/fmicb.2016.01936, Godha K, Tucker KM, Biehl C, Archer DF, Mirkin S. Human vaginal pH and microbiota: an update. Had a ct a few months ago for upper abdominal pain and all came back fine except for mild mesenteric lymph nodes. Without treatment, the infection may spread to surrounding tissue and, in some instances, form a tunnel between the infected abscess and an opening in the skin. clear jelly discharge and abdominal pain . He currently trains Comunity health extension workers (CHEW) in rural communities in Nigeria. I have similar signs. i know im not pregnant cause my tubes are tied. Heart failure: Could a low sodium diet sometimes do more harm than good? Medplux 2019. Vaginal discharge during pregnancy: Your questions answered. There are 2 major causes of clear discharge from the vaginal area. Bethy Last medically reviewed on September 19, 2022, Anal leakage, or fecal incontinence, can cause stool to leak from the anus. Im trying to conceive for 3 years but since I have endometriosis, its very hard for us to have a baby. Articles are intended for educational information purposes only. There is no treatment for HPV, but the virus can produce warts, which are treatable. He has done over 100 c-section and supervised the delivery of over 300 babies. Reply. Your doctors are there to help you and all women lead healthy lives. I am a week early for my period. Christy Some discharge from the vagina and cervix is usual. Abdominal pain is common in pregnancy. I had my periods on the 30/12/2017 to 01/01/2018. le-anne Human papillomavirus (HPV) is a viral infection thats passed between people through skin-to-skin contact. Question: Is clear jelly like discharge a sign of pregnancy or ovulation? When you experience these symptoms together, it's a good idea to get evaluated by your gynecologist. Read on to learn more about diagnosis, treatment, and when to seek advice. 2015;19(2):129-134. doi:10.1097/LGT.0000000000000062. Clear watery discharge or clear discharge is common among women. Hi, Its my 9th day delayed in period and this is my 3rd day having a watery discharge, no color, no odor. Clear stretchy discharge 2 weeks before your next period is usually due to ovulation. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Can you help me. If you experience belly pain with a clear jelly like discharge, it could be due to pregnancy. Also, if your discharge is clear and jelly like, it indicates you are ovulating. J Med Microbiol. 2017;6:1761. doi:10.12688/f1000research.11417.1, Qin F, Wang Q, Zhang C, et al. Usually I am 10 days. Vaginal discharge plus lower abdominal pain suggests pelvic inflammatory disease (PID), i.e. Hi, Ive had 2 missed periods and for the past month Ive had a lot of watery clear discharge. My period changed from a solid 28 days to 48-50 days. singelolycka pite flashback. I was discharged from the hospital after a biliary stent was placed due to bile leakage, and my biloma was not drained. Rectal discharge will usually resolve after treating any underlying GI tract condition or infection. then yesterday i had a weird discharge it was like thick and some of it was clear and kinda slimy it doesnt have a bad odor and the cramps arent like doubleing over cramps it just feels like pressure. Is clear jelly like discharge before period sign of pregnancy? So I ran for home pregnancy test twice but both the result were clear negative I have not experienced any of prego sign either,yet. MNT is the registered trade mark of Healthline Media. I am a little overweight. Not all women with a yeast infection will have symptoms of infection. Reply. Vaginal yeast infections, also known as candidiasis, are common in women. They are just gushes and are a few times a day. Medplux 2019. F1000Res. It is normal and should not worry you. If you are learning about ovulation for the first time, itsnormal for women and means your menstrual cycle is working as it should. January 8, 2018 at 10:17 am June 22, 2018 at 2:33 pm Sexually transmitted diseases (STDs). It is essential to complete the course of antibiotics to prevent reinfection. Dr. Dunn A. clear jelly discharge and abdominal pain. Cervicitis, an inflammation of the cervix, causes pelvic pain, bloody or yellow v The week my period was due I had mild string like & brown discharge 2ce only when wiping. caesar rubikon spruch; fm radio that can connect to bluetooth speaker a couple days ago i started feeling like i was cramping or like there was aot of pressure on my abdomen. Leslie Gonzalez A doctor will evaluate the persons symptoms, carry out tests, and prepare a treatment plan. These may be symptoms of a health condition that needs medical attention. May 24, 2018 at 5:39 pm No period in February & several negative test with last one done 2/20/18. Its better to squat while checking for your cervical mucus. November 12, 2017 at 6:48 am What could this be?!? April 15, 2019 at 10:04 pm Here are some answers to questions people often ask about recal discharge. Brown jelly like discharge, is it normal? I dont want to get excited incase Im setting myself up for a fail again. Read more about cervical cancer and yearly screenings. Thanks in advance for the answer. Im supposed to have my period today, Ive been having cramps since like two days and my period isnt here yet but Im having a watery discharge. Also, last month I was on antibiotic for around 15 days for ear infection. could it still be caner? It could occur after intercourse, during early pregnancy (implantation bleeding), during ovulation, and if you have vaginal infections. Charu This is mostly due to vaginal infection caused by gonorrhea and chlamydia. This pain can be: Vaginal discharge can be normal. 2012;61(Pt 11):1580-1583. doi:10.1099/jmm.0.044578-0. Im now around 36.60 Celsius during period I dropped to my lowest point of around 36.12. martha shepard Often, cervical cancer produces no symptoms until the later stages. Reply. Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. Dr. Akatakpo Dunn is a senior medical officer at the Presbyterian Joint hospital. Hi, i am running 11 days late for my period which was supposed to start from 14th of November. Before ovulation occurs, estrogen hormoneis produced by growing follicle, and it acts to make your vaginal discharge look watery and jelly-like. Seek immediate medical help if your lower abdominal pain is sharp or severe and youre experiencing a fever, uncontrolled vomiting, or chest pain. Most women with clear discharge usually have no symptoms or infection. With lots of crap online, I Hope to quickly give reliable information about health. Ordinarily, your body (the cervix) helps to produce fluid that aids the removal of dead cells and bacteria from your vaginal area, and a whitish discharge is normal if there is no odor. 1. Heavy vaginal discharge for months. discomfort, soreness, or pain in the anal area, bloody stools, either with or without pain, severe or persistent emotional or physical stress, swelling, pain, or tenderness of the skin in the anal region, severe anal pain, especially during bowel movements, irritation or itching affecting the anal region, swelling, pain, or tenderness in the anal area, pain, bleeding, or both during bowel movements, growths of skin, blisters, or open sores on or near the anus, STIs, foodborne illnesses, and other infections, small lumps around and inside the anal area, bleeding from the rectum, usually bright red blood, a feeling that a bowel movement is not quite finished, taking oral pain relievers and anti-inflammatory medications, eating foods rich in fiber, such as fruits, vegetables, and whole grains, cutting a hemorrhoid and the surrounding tissue with a scalpel, aminosalicylates, such as sulfasalazine and mesalamine, corticosteroids, such as prednisone and hydrocortisone, immunosuppressants, such as azathioprine and 6-mercaptopurine, fistulotomy, which involves surgically opening a fistula so that it can drain and heal from the inside. BV is also the most common vaginal infection in females ages 1544 years. Hi, I have been ttc for sometime now and learnt about BBT and ways to improve fertility etc. Some STIs that can affect the anal area include: Some common symptoms of STIs in the anal region may include: Proctitis is a condition characterized by a persistent or frequent need to empty the bowels. (2022). The last 2days Ive been get lots of watery cm, feel like Ive wet myself. February 11, 2018 at 6:58 pm If the vaginal discharge is related to sexual arousal, it is entirely normal. And when period stop, I am OFF only for two weeks and ON again. It is normal for every woman to have vaginal discharge as it helps to keep the vaginal canal clean and free from infection. The doctor may use one or more of the following tests to confirm a diagnosis: Treatments will vary depending on the underlying cause.