If your palms are burning, depending on your worldview, a person looks for the cause in folk signs or medical reference books. Let's try to figure out why our palms itch and burn? Let's look at the medical reasons and compare them with signs.
Perhaps they do not contradict each other?
There is only one sign that explains why your palms suddenly begin to literally burn. It is believed that a similar effect occurs if you soon have to say goodbye to a significant financial amount.
At the same time, the sign clarifies - either you will be robbed, or you yourself will donate money to the scammers. In any case, it will be an irrevocable loss when the police cannot help. This can be described as the beginning of a kind of black streak that will not last forever.
In the end, light will appear in the tunnel and the financial situation will stabilize.
Now let’s see how this sign corresponds to the realities of life. It’s curious, but folk wisdom does not contradict science at all. The fact is that the palms of the hands and feet begin to itch in the case of a number of diseases.
Naturally, you will have to spend money on diagnosis and treatment. Depending on the cause of the pathology, treatment can be very expensive. However, if the problem is resolved in a timely manner, the financial situation will return to normal.
And now that we have found out that the sign has a real basis, let’s see what diseases are accompanied by similar symptoms.
If you are a realist and do not believe in omens, the first thing you should do is visit a dermatologist, since very often unpleasant sensations in the area of the legs and hands are associated with dermatological problems.
However, you should not think that skin diseases are the only cause of the symptom; in fact, the list of pathologies is much wider:
If you are a person who is accustomed to looking for a mystical background in everything, you can go to church and light a candle or visit a psychic if you experience itching in your palms.
But a person who is accustomed to looking at things realistically will definitely try to find out why an unpleasant symptom arose and eliminate the problem with the help of the achievements of modern medicine.
Many people have encountered the problem of burning the soles of their feet or burning heels. You can get rid of such a nuisance only after first identifying the cause.
According to many doctors, when burning legs occur, the causes can be divided into the following categories:
The key reasons why your feet bake may be:
Treatment should begin only after the reason why the legs may be burning has been determined.
The reason that a burning sensation appears in the legs can be diseases of the internal organs and systems, accompanied by fever. If a fungal infection develops, symptoms manifest themselves regardless of age and gender - a burning sensation appears, the toes itch and burn, the feet turn red and begin to peel. The heel epidermis begins to crack, the nail plate changes its color and structure.
Another endogenous factor that can provoke a burning sensation is varicose veins. More often it develops in the fair sex, this is due to wearing high-heeled shoes, as well as pregnancy. The load on the heels and feet provokes the appearance of swelling, pain in the calves, bulging veins outward, and the soles of the feet begin to burn. Obliterating endarteritis can cause intense burning of the feet and heels. The cause of this disease is an infection that spreads to the arteries of the lower extremities. When this disease develops, the leg below the knee, sole and heel burns. Other manifestations of this disease are lameness and convulsions.
Another disease that causes fever is thrombophlebitis. When thrombosis occurs, the lower limb swells, burns, and is also hot to the touch. Not only the sole hurts and burns, but the entire limb. Atherosclerotic disease of the vascular system can cause pain and fever at night. Why do your heels and feet burn? Another cause could be an ailment such as peripheral neuropathy. It becomes a catalyst for serious problems with the lower extremities. This disease appears against the background of diabetes mellitus. Treatment must be immediate. Why do heels burn? Cracks in the epidermis of the heels can cause this problem. The reason for this may be improper care, vitamin deficiency, or fungus.
If your feet begin to burn in the evening, this may be due to prolonged walking or wearing tight and uncomfortable shoes made of synthetic materials. This symptom can be a consequence of walking in high heels.
When heat appears in the legs, blood fluid stagnates. After uncomfortable and tight shoes are removed, the muscles and blood vessels relax sharply. There is a sharp flow of blood to the legs, a burning sensation appears.
Often this symptom appears in the last trimester of pregnancy. A growing fetus causes swelling, muscle tone deteriorates, the load on the limbs increases, and body weight increases.
The result of such factors is stagnation of blood in the legs, increased permeability of the vascular walls, irritation of the nerve roots, and discomfort. Women during pregnancy often develop varicose veins, which also causes a burning sensation.
Frequent stress, emotional overload, fatigue, nervous shock, and climatic conditions such as heat and high humidity can cause discomfort and burning in the feet and heels. Such conditions easily lead to dysfunction in the vegetative-vascular system, resulting in severe narrowing or dilatation of blood vessels, accompanied by heat and discomfort, tingling in the soles.
Other causes include: heel spur, genetic predisposition, allergic reactions to exogenous allergens, flat feet, obesity, vegetative-vascular dystonia.
When a feeling of heat appears, procedures such as baths using hot water are not allowed. Slightly heated water can harm already hot skin. The first aid for such manifestations is a cool or cold bath. You can also run your feet under cold running water. The duration of the procedure is at least two minutes.
After water procedures, you need to thoroughly dry the skin, apply a cooling agent (cream or ointment) for the feet with a cooling effect. Typically, such products contain mint or menthol. It is necessary to apply the product in the direction from the foot to the calves, using light massage movements, gently rubbing into the skin.
Treatment with folk remedies involves the use of herbal decoctions, infusions and lotions. You can make baths based on decoctions of medicinal plants that relieve inflammation, itching, and burning. The following plants are used for these purposes:
To prepare a foot bath, you can take each herb individually or a complex of herbs. The raw materials are taken in equal parts, poured with boiling water, and added to cool water. Pour the prepared solution into a container and immerse your feet in it for a quarter of an hour. In addition to using herbal decoctions for baths, you can eliminate burning and fatigue of the feet with the help of compresses and lotions. For this, hop cones, spruce buds or pine buds are used. An application is prepared from these ingredients, which eliminates heat and strengthens vascular and venous walls.
To prepare such a compress, take two tablespoons of dry raw materials and pour a glass of boiling water. Let it brew for several hours. Next, you need to soak a piece of clean gauze or cotton cloth in the broth, apply it to the sore spot, and cover it with cellophane and a towel. After this treatment, the fever goes away and the intensity of the burning sensation decreases.
Among the large number of treatment options with folk remedies, there are other options for relieving tired legs. An effective method of getting rid of burning sensation is to treat the skin with a mixture of ammonia and vegetable oil. This composition is used to treat painful areas of the limbs.
The effectiveness of this product is dictated by the fact that, thanks to ethanol, muscle spasm is eliminated, and the oil prevents drying of the skin, saturating it with useful substances. It is not difficult to make such a compress - soak a piece of clean cloth or gauze in the mixture, wrap the painful area of the leg, cover it with cellophane, and put on warm socks. After this treatment, leg fatigue disappears and the intensity of burning decreases.
In extreme heat, it is recommended to apply vodka or alcohol to the skin; this will warm it; if there are cracks, they are disinfected, reducing the severity of the inflammatory process.
An effective method for getting rid of fever is blue clay. Based on it, compresses or applications are made, which are applied to painful areas, wrapped in cellophane and put on warm socks. This procedure lasts no more than an hour, after which the foot is rinsed under warm water. You can wipe your skin with a clean piece of cloth or napkin pre-treated with tea tree oil. Treat both left and right legs the same way, regardless of which one is baking.
In extreme heat, it is recommended to take a foot bath using soda. Boil half a liter of water, cool slightly, add 3 tablespoons of soda. Pour the solution into a container and place your feet in it. The duration of the procedure is no more than 20 minutes. Then dry the skin well, wipe with a cotton pad soaked in triple cologne. With this treatment option, the skin of the feet softens, the burning sensation goes away, and cologne helps disinfect, eliminate pathogens, and promote the healing of wounds and small cracks.
If you often experience a burning sensation in your feet or heels, it is recommended to take preventive measures. This will help prevent the occurrence of unpleasant symptoms. It is recommended to purchase only those shoes that will be convenient and comfortable; women should limit wearing high heels, shoes that are too tight and uncomfortable, or with pointed toes.
Sometimes we feel an unpleasant burning sensation in our feet, sometimes accompanied by pain and heaviness, as if our feet were burning. Such a feeling can be frequent or rare, appear after some specific actions of ours, or simply accompany our day, and sometimes morning and night. Let's figure out why your feet burn and how you can deal with it.
Usually the feet burn in the evenings in people wearing uncomfortable and tight shoes or high heels. This is due to the fact that when the foot is compressed, the blood flow stagnates, and after removing uncomfortable or tight shoes, there is a sharp relaxation of the muscles and blood vessels. Trying to compensate for stagnation, the body increases blood flow, and the feet feel as if they are burning.
In pregnant women, such complaints most often occur in the third trimester. This is due to the development of edema and laxity of vascular muscles due to pregnancy hormones, as well as increased load on the legs, because a pregnant woman gains weight. As a result of stagnation of blood flow, vascular permeability increases, toxins accumulate, irritating nerve endings and, as a result, the woman feels a burning sensation in her legs below the knee and/or feet. In other cases, this may be a sign of the development of varicose veins or thrombophlebitis.
This can be stress, overwork, nervous overexcitation, extreme heat and other situations leading to disorders of the vegetative-vascular system. As a result of this, the vessels can sharply narrow or, conversely, expand, leading to an outflow or influx of blood, which will cause the feeling as if the feet are burning.
The reasons are either the same “vascular game” as described above, or damage and/or irritation of nerve endings.
If your feet are burning, under no circumstances should you take hot or even warm baths , much less steam your feet. Cold baths are also not allowed. It would be ideal to take a contrast shower or foot bath for 1-2 minutes with warm and cool water for a quarter of an hour. You need to start and end with cold water. At the end of the procedure, you can lubricate your towel-dried feet with any mint cream. Lubricate in the direction from the foot upwards. This rule should apply to any foot creams.
Baths can be used with herbs, such as mint, chamomile, wormwood, calendula, and linden blossom. To do this, you need to infuse two tablespoons of any herb or mixture of herbs in equal proportions in one liter of boiling water.
Foot compresses with blue clay help very well . You need to apply clay to your feet, maybe up to your knees, and wrap them in a plastic bag for an hour or two. Then wash off the clay with water at room temperature, and again you can use any menthol foot cream.
You can also use compresses from hop cones or pine buds . It is necessary to infuse 2 tbsp in a glass (200 ml) of boiling water. spoons of raw materials for an hour until the infusion reaches room temperature. Then soak a clean linen or cotton cloth in it and wrap your feet for 15–30 minutes.
Foot massage helps very well ; it can be done by a professional, or you can do any kneading movements yourself.
It is imperative to establish proper healthy nutrition . Avoid salty, fried, fatty, spicy, overly spiced foods, as well as soda, beer and alcohol abuse.
But you need to understand that these recommendations will only help cope with the burning sensation itself, but will not eliminate the cause. Therefore, you need to choose good, comfortable shoes and be sure to treat the underlying disease, if any.
If your feet are burning, there can be many reasons for this condition. And the lower limbs may have absolutely nothing to do with this phenomenon. Often the feet burn in older people, this is due to the fact that their body’s resistance to various diseases decreases with age. The medical name for this phenomenon, when the heels burn or the soles bake, is Gopalan syndrome. It may be accompanied by symptoms such as a feeling of heaviness, pain, and sometimes even itching. Increased burning sensation in the feet at night.
Why do my feet burn? The reasons can be exogenous and endogenous. If your feet are burning, the causes may be hidden in the following diseases or conditions:
To find out why your feet are hot, you should definitely visit a doctor, undergo an examination, find the cause and treat it. Burning of the heels of the feet is not an independent disease, but a symptom of pathological processes occurring in the body.
If the soles of your feet burn, the reasons may be:
If the soles are burning, the cause must be discovered, after which treatment is prescribed.
Wearing synthetic items or shoes can trigger the development of an allergic reaction even in those people who are not prone to allergies. Often such pathological processes are the body’s reaction to poor-quality insoles. As a result, throughout the day, and especially at night, a symptom such as fire in the sole appears. Moreover, as a result of wearing low-quality tights or shoes, a burning sensation may appear and the child’s leg may suffer.
In addition to the fact that the soles and heels of the feet burn with fire, symptoms such as itching and red spots appear. There may also be a reaction of the skin to low-quality materials from which things are made - tights, socks.
Certain cosmetic or pharmaceutical products used to reduce sweating or to care for feet and heels can also trigger the development of an allergic reaction. In this case, the legs turn red, itch and burn.
What to do in this case - it is necessary to identify the cause of the allergic reaction. If your toes burn very badly and the symptoms are severe, it is recommended to use antihistamines for treatment. They are taken orally in the form of tablets, and the skin surface is additionally treated with antiallergic agents - ointments, creams.
A symptom such as burning may be the cause of a disorder in the venous system. Superficial veins dilate and lengthen in different parts of the body, most often the legs suffer from this disease, and the consequence is that the foot bakes. The following predisposing factors may influence the appearance of varicose veins:
The disease begins its development with the appearance of swelling and heaviness in the lower extremities, and a burning sensation also appears in the calves. Marks from socks and shoes may remain on the skin. Swelling veins are visible. Only a doctor can tell you how to treat such a disease; in each case, a separate approach to treatment is selected and a treatment regimen is drawn up. If necessary, treatment adjustments are prescribed.
To eliminate the disease, therapy with medications, laser therapy, and surgery is prescribed. Proper nutrition must be prescribed to reduce weight if necessary. An effective method is sclerotherapy.
One of the signs of the development of a fungal infection on the feet, fingers, nails or heels is a burning sensation. You can become infected with the fungus when visiting public places or during contact with a sick person, or when wearing someone else's shoes and socks.
At first, symptoms such as peeling, itching, redness appear, after which the legs become covered with cracks and they hurt. If the pathological process spreads to the nail plates, they acquire a yellow tint, begin to become colored, and peel off.
Burning becomes the next stage in the development of a fungal infection. The doctor will tell you how to cure this disease. It is better not to self-medicate, since the doctor draws up a specific treatment regimen; therapy should be comprehensive, including proper hygiene and care, and improved nutrition. At the same time, shoes are treated with antifungal drugs. The feet are treated with special ointments and creams that are designed to fight fungal spores and inhibit their further development.
If your feet are burning, it means diabetes may be the cause. This disease is characterized by a decrease in insulin in the body or its complete absence. Under the influence of the hormone, glucose is evenly distributed in the blood fluid and absorbed by cells. If there is not enough of this hormone in the blood, glucose levels increase, resulting in disturbances in the vascular system.
A person begins to feel painful sensations, the heels begin to burn strongly after walking, when the disease continues to develop, the legs become hot even when the person is at rest. The skin becomes pale, and the phalanges of the fingers become blue.
What to do in this case - treatment for such a disease involves timely contacting a doctor. If diabetes mellitus is present, therapy should be carried out continuously. Thanks to medications, you can maintain blood sugar at the proper level. The skin of the feet needs constant care to prevent the development of bacterial processes and to prevent the appearance of trophic ulcers and suppuration in diabetes mellitus.
This disease is characterized by damage to the arteries by infectious agents, a disturbance in blood circulation occurs, as a result of which the lower extremities suffer. The result is symptoms such as numbness and fire in the soles. As the disease progresses, lameness and cramps in the calf muscles appear.
The patient begins to feel a burning sensation from the inside during the day, and in the evening the burning sensation is accompanied by swelling, heaviness, and increased fatigue.
If nothing is done, then suppuration appears. What can be done? Therapeutic measures are aimed at strengthening the tone of the vascular and venous walls and establishing normal blood circulation. Medications and physiotherapeutic procedures are also used. For advanced forms of the disease, surgical treatment is used.
There are many reasons why the feet burn - flat feet, tight shoes or serious illnesses. Thrombophlebitis, obliterating atherosclerosis, varicose veins, other vascular pathologies, as well as radiculitis and osteochondrosis - all these diseases can lead to burning of the feet.
And therefore, first you need to treat the underlying disease. In other cases, the feet can burn due to stress, emotional and physical overload, in the second half of pregnancy in women and, of course, while wearing uncomfortable or rubber shoes.
I think that everyone is familiar with this state: I took off my new, unworn shoes in the evening and my feet began to “hum.”
This occurs due to the so-called “vascular play”, when after a spasm caused by the above reasons, a sharp expansion of the veins occurs with increased blood flow. As a result of prolonged stagnation of blood in the capillaries, the toxins that have accumulated there affect the nerve endings and cause a burning sensation and even pain.
So what should you do to prevent your feet from burning? Under no circumstances should you steam your feet - neither in salt water nor in ordinary water: this will only, as they say, add heat to your feet and only increase the burning sensation in your legs. Take contrast baths or showers, alternating not too warm and cold water - 1 - 2 minutes each, for a total duration of 10 - 15 minutes.
This procedure strengthens the walls of blood vessels well, should be soothing, pleasant, and not cause a desire to stop it as soon as possible. Baths must be finished with cool water. Then dry your feet and lubricate your feet with some menthol gel or cooling cream.
By the way, when you use foot cream, regardless of the reason for its use, always apply it from the bottom up - from the foot to the knee. This helps the blood flow well: the vein contracts, raising the blood upward with all the toxins and waste accumulated during the day. This is the essence of improving venous circulation.
• If your feet burn too often and pain occurs, take contrast baths with infusions of medicinal herbs - chamomile, calendula, wormwood, linden blossom: pour 1 - 2 tablespoons with 1 liter of boiling water, let it brew. Herbs will relieve tension. You can also use sea or table salt in a course of 10 - 15 daily procedures.
• Herbal lotions, compresses with horsetail or hop cones are also very effective - they help remove waste and toxins. Pour 2 tablespoons with a glass of boiling water, let it brew to room temperature, moisten a cloth folded in several layers with the resulting infusion and wrap your feet.
• Blue clay helps with burning feet: apply a thin layer of clay to your feet, wrap them in plastic, put on socks. After 2 - 3 hours, wash off the clay without soap with warm water.
• External treatment would be very well complemented by ingestion of infusions of medicinal herbs. For example, the fruits and flowers of hawthorn reduce the permeability of blood vessels and capillaries, improve blood flow: grind 2 tablespoons of dry fruits, pour 300 ml of boiling water, let it brew, strain and drink 30 minutes before meals, 3 times a day, 100 ml. You can also use a pharmacy tincture: drink 30 drops 3 times a day before meals.
• Horse chestnut flowers are used in the treatment of blood stagnation: pour 2 tablespoons of 0.5 liters of boiling water into a thermos and let it brew. Drink warm during the day.
• Also, if your feet are burning, foot massage has a great effect. Massage each toe thoroughly, as if stretching it, then elastically knead the entire foot. The use of the Kuznetsov applicator gives an excellent effect in relieving foot fatigue. While sitting in front of the TV, place your feet on the applicator and apply light pressure on it without pain. If you don’t have an applicator, use a spiky mat, which is usually placed in front of the entrance, or pour small peas and gravel into the tray and “walk” on it.
And the last piece of advice: don’t get carried away with beer, carbonated drinks, spicy foods and seasonings, limit salt. These products provoke stagnation of venous blood and lymph.
The burning sensation in the feet that people sometimes experience is quite unpleasant.
If this symptom appears regularly and causes significant discomfort to a person, it is imperative to determine the reasons why the soles of the feet are burning and begin treatment with medications and folk remedies.
This ailment is not an independent disease . If your feet regularly burn, look for the cause in systemic diseases.
Most often, this symptom accompanies the following pathologies:
The feeling that the soles of your feet are burning may be an allergic reaction to the materials that the skin of your feet comes into contact with.
These could be low-quality insoles, synthetic socks, creams and lotions used for foot care. New washing powder and even flooring can lead to allergies.
If the discomfort is of an allergic nature, in addition to a burning sensation, you may also notice obvious manifestations of a reaction on the skin.
The latter may become covered with a rash or red spots accompanied by itching. If the culprit of burning feet is an allergic reaction, in order to get rid of the unpleasant symptom, it is enough to prevent skin contact with the irritant.
Vascular pathologies in the lower extremities can also lead to a burning sensation in the feet.
All of these problems require complex treatment under the guidance of a vascular surgeon . The doctor will prescribe you a course of blood thinning and vascular wall strengthening therapy. During the treatment period, it is recommended to walk more.
A fungal infection can also cause itching and burning of the skin of the feet. Mycosis is the most common reason why the feet burn . You can become infected with fungus in public places - swimming pools, baths and saunas.
Initially, the disease is localized in the interdigital folds, where it causes peeling. Then the fungal infection spreads to neighboring areas of the skin, and it begins to itch, redden and burn.
Fungus should be eliminated under the supervision of a dermatologist . Based on laboratory tests, a specialist will determine how to treat the disease and select the necessary medications that can combat mycocolonies that have affected your skin.
Not only vascular diseases and fungal skin infections can lead to burning feet. Pathologies of the nervous system, in particular vegetative-vascular dystonia, can also cause this symptom.
The syndrome is characterized by specific symptoms: dizziness, regular presyncope, sudden tachycardia and pressure surges.
In diabetes mellitus, the level of insulin is reduced or not produced at all by the endocrine system, which causes the concentration of glucose in the body to increase.
An excess of sugar has a strong effect on small peripheral vessels, damaging their structure. First, painful sensations appear in the feet after walking, then a burning sensation occurs in the fingers and feet.
As blood vessels are damaged in diabetes mellitus, these sensations begin to appear at rest. Damaged capillaries die, and the skin on the feet becomes pale and blue in the periphery.
If you miss the development of this process and do not adjust the treatment of diabetes, ulcers will appear on the lower extremities, and gradually the tissue will begin to die.
The feeling that your feet are burning can cause a metabolic disorder such as gout . It is characterized by an increase in the level of uric acid in the blood, the crystals of which are deposited in tissues and organs.
The small peripheral vessels of the lower extremities begin to suffer most from gout.
A burning sensation in the fingers and toes is the very first sign of the development of gout . If you feel them, you should contact a rheumatologist.
Deficiency of B vitamins usually manifests itself as a burning sensation in the feet..
Thus, small vessels in the lower extremities react to the lack of substances important for metabolic processes.
In addition to this specific symptom, with a deficiency of B vitamins, evening and night cramps and deterioration in the condition of nails and skin are noted.
Taking a course of multivitamins and adjusting your diet will help solve this problem . The diet must include fresh vegetables, meat and offal.
Pregnant women may experience a burning sensation in their feet during the third trimester..
An increase in weight, and therefore increased load on the lower extremities, leads to increased pressure in the vessels of the legs and the occurrence of swelling. All this reduces blood flow to the feet.
The treating gynecologist, in response to your complaints, recommends that you restrain your fluid intake and lie more often with your legs elevated on pillows.
If the feeling that your feet are burning appears sporadically and mainly in the evening, the reason for this may be overwork of the legs. Tight shoes and long walks lead to “vascular play.”
During the evening rest, pinched veins and capillaries begin to expand, which causes a burning sensation on the feet.
When you notice that your feet are burning, listen to yourself, understand what other symptoms are bothering you and approximately determine what disease the burning sensation may indicate.
After this preliminary self-diagnosis, make an appointment with the right specialist. If you cannot attribute this symptom to any systemic disease, and it bothers you every day, go to your local physician.
He will examine you, collect anamnesis and give a referral to a specialist who can accurately determine why the soles of your feet are burning and what to do about the problem.
In the meantime, you are waiting to see a doctor, you can alleviate your condition by eliminating the unpleasant symptom in the following ways:
Using these methods, you can temporarily relieve an unpleasant symptom. Together with the doctor you contact, you can find the reason why your feet are burning and solve the problem with medication.
Most likely, the doctor will reveal that you have typical neuralgia of one of the nerves - the ulnar, radial, median, and, more precisely, their cutaneous, superficial branches. This disease most often occurs against the background of ganglionitis of the cervical sympathetic nodes.
The following factors contribute to this:
Therefore, if your skin hurts, like a burn, then go to the doctor as soon as possible. It is possible that these symptoms may be harbingers of a more serious disease - intercostal neuralgia or pinched nerve.
There is such a disease as skin hyperalgesia. This is an increase in pain sensitivity of the skin. With this disease, the most common symptom is pain on the skin, like a burn. In order to diagnose this disease, it is enough to run a soft brush over the patient’s skin. In a patient with hyperalgesia, sensitivity in places of touch will be increased. Even with the slightest touch, a person will feel that the skin hurts as much as a burn.
Many doctors associate pain with the patient’s mental state. Many people who seek help because their skin hurts, like a burn, have previously experienced serious psychological trauma. This is how the body reacts to internal pain.
If you start to notice that your skin hurts, but you haven’t injured it, think about it. Remember, perhaps before this you were depressed for a long time and were subject to numerous stresses. If this is the case, then seek help from a doctor who can prescribe effective therapy.
Some doctors claim that skin pain, like a burn, can be caused by the herpes virus. Or a childhood disease such as chickenpox (chickenpox). In some cases, it occurs without the appearance of blisters and is accompanied by pain in the skin, which feels similar to a burn.
As you can see, this symptom manifests itself in a number of diseases, both physical and psychological. In order to be calm about your health, do not delay visiting the doctor. And be less nervous and worry. After all, we all remember very well that almost all diseases are caused by nerves.