Seek immediate emergency medical help if you think youre experiencing an ectopic pregnancy. Round ligament pain often starts as the belly grows in the second trimester. Let your doctor know if youre experiencing miscarriage symptoms. Factors such as abnormal menstrual cycles can increase endometriosis risk. Appendicitis is an inflammation of the appendix, the small finger-shaped organ located on the distant portion of the colon. In addition to pelvic pain, other symptoms of PID may include upper abdominal pain, fever, fatigue, vaginal discharge, irregular bleeding, or painful sex or urination. Ectopic pregnancy is a medical emergency. Ovarian cysts are relatively common and can appear at any age.
Second trimester pains: Causes, symptoms, and treatment However, pain accompanied by spotting or bleeding should be reported to your doctor. Although most instances of numbness and tingling in pregnancy are normal, there are some more serious conditions that include numbness and tingling as symptoms. Leg cramps are a common cause of pain during the second and third trimesters of pregnancy. IBD is not necessarily fatal, but without treatment it can lead to serious health complications, such as malnutrition, severe blood loss, bowel perforations or obstructions, or even colorectal cancer. Long COVID may impact quality of life worse than cancer, other diseases. Crohns disease and ulcerative colitis are the two main types of IBD, and each differs in location, severity, and clinical progression. But any pain along with spotting or heavy bleeding should be reported to your doctor. With that said, any bleeding during pregnancy at any time is a solid reason to contact your providerespecially if youre also experiencing pain. The tailbone might also look like its sticking out after weight loss or injury. Some pregnant women do feel round ligament pain on both sides, though. The CDC previously stated your risk, That sudden, sharp vaginal or pelvic pain you may feel late in pregnancy is called Lightning Crotch. Wear a belly support garment or belt to help lighten the load on your pelvis. More importantly, its difficult to determine serious symptoms from minor signsand time is a factor when it comes to more serious conditions like preeclampsia and preterm labor. While shooting pain in the pelvic region is common in conditions that affect the female reproductive tract, it can occur with other health conditions, including kidney stones, that affect all genders. If none of the above techniques work, or if your contractions last for longer than two minutes at a time and seem to get closer together over time, you may be going into labor and should call your doctor, the ACOG explains. You can learn more about how we ensure our content is accurate and current by reading our. These pains, called Braxton Hicks contractions, are a normal part of pregnancy, and while they may be uncomfortable, they usually arent painful. You may also notice that youre peeing less frequently, or your doctor might flag kidney problems like excess protein in your urine, the Mayo Clinic explains. That said, it can seem like labor pain, especially if its your first pregnancy. Our team thoroughly researches and evaluates the recommendations we make on our site. In these cases, at-home treatments, physical therapy, or doctor-approved pain medication are all that is required for relief. Constipation is generally caused by a poor diet, although there may be other underlying causes, such as certain medications. One of the most common sharp pains that women report is a stabbing pain in and around the uterus, stomach or groin area. A pending miscarriage can also result in a sharp pain from the cramping. Any activities that increase the risk of STIs can increase PID risk. Let medical staff know youre pregnant and report any symptoms such as dizziness, nausea, or faintness right away. Female reproductive system. Whether youre dealing with swollen feet or morning sickness, there are plenty of run-of-the-mill pregnancy aches you might experience. This is a normal part of pregnancy and a sign that everything is progressing normally. 1. Having a prenatal massage may not prevent lightning crotch, but massages can relax the muscles and may ease overall aches and pains during pregnancy. The length of time a miscarriage lasts varies from woman to woman, as do the risk. Antibiotics are the first line of treatment for PID, and early treatment is important to prevent the infection from spreading to other areas of the body. Unfortunately, theres no current cure for IC, but medication can be used to help reduce bladder pain. Feels like a "pins and needles," a loss of sensation, or a radiating burning or tingling that is accompanied by pain 3. Thank you, {{form.email}}, for signing up. Most pregnant people know that labor is comprised of uterine contractions, but many dont know that they can start experiencing contractions as early as the second trimester, according to the Cleveland Clinic. Ectopic pregnancy occurs when a fertilized egg attaches itself in a place other than the inside of the uterus, usually in the fallopian tubes. A swollen and infected appendix can sometimes rupture and become life-threatening, so surgery is often necessary to remove it as quickly as possible. Drink at least 10 cups of water per day to help relieve gas pain and bloating. Signs of labor include: Some aches and pains are common during pregnancy, so it can be hard to know when to see a doctor. IBD can cause severe abdominal pain, including both cramp-like pain as well as sharp, stabbing pain. Last medically reviewed on January 2, 2019. Medical News Today only shows you brands and products that we stand behind. Some common causes include: SELF does not provide medical advice, diagnosis, or treatment. If you are dealing with major abdominal pain during pregnancy, it can be hard to figure out how best to minimize it because there are so many potential causes. General numbness and tingling of the hands, fingers, back, legs, and buttocks during pregnancy can be treated by a gentle massage, making sure to vary your sleep positions (using a pregnancy body pillow helps a lot), soothing baths, and stretching. While this can be uncomfortable, in many cases it can be explained by normal changes that occur during pregnancy. If youre pregnant with twins or multiples, you may feel your uterus stretching sooner. In cases where your provider decides that surgery isnt right for you, they might prescribe antibiotics to treat infection and remove your appendix at a later time. Similarly, as your uterus grows heavier and fuller, it puts an unusual strain on your muscles, ligaments, and nerves, which can also contribute to sensations of numbness and tingling., As you move toward the second and third trimester of pregnancy, swelling of the hands and feet is common due to water retention. This could signal appendicitis (inflammation of the appendix). Cramping during pregnancy is not always a sign that something is wrong. For some women, this excess fluid puts pressure on the median nerve in the wrist, causing carpal tunnel syndrome.. A high risk pregnancy is any pregnancy that comes with increased health risks for either the pregnant parent, the fetus, or both. A hernia occurs when part of an organ or tissue breaks through the muscles of the abdominal wall. If you suspect any of the following conditions, you should discuss them promptly with your healthcare provider, as they can lead to dangerous complications during pregnancy. Procedures such as lithotripsy, ureteroscopy, and tunnel surgery may be used to help larger kidney stones pass, along with pain medications. Ther Adv Musculoskelet Dis. Not only can these symptoms become irritating and sometimes very uncomfortable, but they may leave you asking, What exactly is going on here?. 2015;122:1112-1118. doi:10.1111/1471-0528.13360. It is typically associated with fever, inability to eat, nausea, and vomiting. See your doctor right away if youre in pain and suspect something is wrong. Thats because the pregnancy hormone progesterone causes the smooth muscles in both the esophagus and bowel to relax. The pain can be felt in the front or back portion of the pelvis, can be acute or chronic, and can feel different depending on the cause. First, doctors will perform a series of tests and scans to confirm that you have appendicitis, SELF previously reported. Bladder infection (urinary tract infection UTI) in adults. Neuralgia can also cause general discomfort, and even numbness, in the area surrounding the nerve. Once a miscarriage has started, there is no treatment for saving the pregnancy, but in some cases medication or surgery is needed. (2015). During pregnancy, the body releases hormones that loosen and stretch certain ligaments in preparation for childbirth. It is essential to go to an experienced, certified massage therapist who specializes in prenatal massage. Can diet help improve depression symptoms? Labor often comes with menstrual-type lower back ache or pain which lasts a long time. During the first weeks of pregnancy, you likely wont notice your uterus growing or expanding. If left untreated, UTIs can spread to the kidneys and into the blood, causing a life-threatening condition called urosepsis. If the pain is new and not going away, then you should be evaluated, especially if youve had problems with your blood pressure during the pregnancy, Dr. Clark adds. Generally, treatment involves surgery to drain the abscess, followed up with antibiotics to prevent the spread of infection. Endometriosis can cause severe pain and other symptoms. The doctor will need to check for infection or other complications. We avoid using tertiary references. As your pregnancy progresses and you get bigger and bigger, the two ligaments that attach the uterus to the abdominal wall, called round ligaments, begin to stretch and strain, causing pain, according to the Mayo Clinic. A hernia thats accompanied by sudden and severe pain, nausea, vomiting, or fever should be treated immediately to prevent further complications. This condition usually develops in the third trimester of pregnancy and is usually mild, but can be debilitating for some women. Lightning crotch usually feels like a sharp pain or electric jolt in the pelvis or vagina. MNT is the registered trade mark of Healthline Media. Kesikburun S, Gzelkk , Fidan U, Demir Y, Ergn A, Tan AK. Here are the main differences: Though lightning crotch can be jolting and disruptive, its usually nothing to worry about. Certain underlying conditions, such as diabetes, can increase the risk of developing kidney stones. Could eating more nuts help boost memory later in life? Its common to experience lower back pain during pregnancy, and sometimes this pain radiates down your legs and buttocks, especially if pressure is put on your nerves. Learn about other solutions to consider. See a doctor if any of the following symptoms develop: Before using pain relievers during the second trimester, it is vital to speak to a doctor. You wont feel it in the groin or vagina like lightning crotch. We discuss safety, cost, Healthline-approved. Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation: Two case reports. Home remedies can usually relieve second trimester pain, and the best approach will depend on the type of pain.
Sharp Pain During Pregnancy - American Pregnancy Association In some cases, the gallstone can cause cholecystitis, which is inflammation of the gallbladder, the Mayo Clinic says. Bharucha AE, et al. U.S. National Library of Medicine. Wear a supportive belly band to reduce the pressure on your lower uterus. Pregnancy-related low back pain. American Academy of Family Physicians. Most common causes of second trimester pain do not require medical attention. BJOG. Unfortunately, theres not much you can do when Lightning crotch hits, other than grin and bear it. The good news is that this pain comes and goes quickly, and you wont have to deal with it for long. Your doctor can assess your symptoms at any point during your pregnancy to determine if you need medical care. Its not serious, The Epstein-Barr virus (EBV), or human herpes virus 4, is a part of the human herpes virus family and is, Establishing Paternity with Paternity Tests, Can I get pregnant ifand other questions about conception, Products & Tests to Support Your Pregnancy, Supplements and Medications for a Healthy Pregnancy, If the sharp pain is continual after resting or adjusting (round ligament pain shouldnt last more than a few minutes), If the pain makes it difficult to breathe, walk or speak. Here are a couple of things you can try for relief: While there are different types of pelvic pain in pregnancy, they can feel similar. They help by taking some weight off the pelvis. Early detection is also key. Jordan, R. (2014). Last medically reviewed on November 26, 2018, Eating a healthful diet is particularly important during pregnancy. There are many possible causes for pelvic pain in women. 2018;11(3):104-109. doi:10.1177/1753495X18754577. During pregnancy, the expanding uterus causes these ligaments to stretch. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Centers for Disease Control and Prevention. Babies breathe in the womb very differently than they do after birth. All rights reserved. Many pregnant women experience vaginal and/or pelvic pressure. Kidney stones can be incredibly painful and can cause sharp, stabbing pains on either side of the lower back, in the lower abdomen, or in the groin area. Its not serious or a sign of labor. With round ligament pain, you may experience what feels like a spasm on the right side of your abdomen or right hip. The second trimester lasts from weeks 13 to 28. Heres how to know the difference. Other symptoms of an ovarian cyst may include bloating, nausea, vomiting, and pain during bowel movements or intercourse. Moving in a certain way may cause the ligaments to stretch too far or too fast, causing sudden, sharp pain. What is inflammatory bowel disease (IBD)? Below are the most commonly reported symptoms of numbness and tingling in pregnancy: An uptick in symptoms upon waking up, in the middle of the night, or when performing certain movements with your body 2. In addition to abdominal pain and vaginal spotting, you might also experience extreme lightheadedness, shoulder pain, and fainting, the Mayo Clinic notes. Symphysis pubis dysfunction can also result from hormonal changes. Definition and facts for kidney stones. Even if you havent experienced major pregnancy pain yet, prioritizing your health and well-being can go a long way toward helping you minimize the aches and pains you might encounter. It usually occurs in the third trimester, but some pregnant people with certain risk factors are monitored for it earlier than that. To establish that the product manufacturers addressed safety and efficacy standards, we: We do the research so you can find trusted products for your health and wellness. You can think of them as growing pains.. Gas and constipation are common during the first trimester of pregnancy. Gibbs, R. (2008). Watch for spotting or painful cramping. The problem is that all of this opening up and mobility can cause instability in your body and lead to shooting pain, tenderness, numbness, and tingling in your lower back or legs. Pelvic pain arising from the female reproductive system might be caused by conditions such as: Adenomyosis. Pregnancy: Having a healthy pregnancy. BMJ Open. Treatment for kidney stones depends on the type, size, and number of stones larger kidney stones are more difficult to pass naturally. Philadelphia: Lippincott Williams & Wilkins. Pelvic pain is common with pelvic floor dysfunction and can range from a mild cramping sensation to bouts of sharp, stabbing pains in the pelvis. Constipation frequently causes an increase in gas within the digestive tract, which can lead to sharp cramps or stabbing pains in the lower abdomen. Pudendal neuralgia can cause sharp, stabbing, or burning pain within the pelvis depending on the severity, this pain can sometimes extend down to the genitals. Doctors are unsure why lightning crotch develops in some people but not others. In addition to chronic or intermittent pain, IC can also cause pressure, discomfort, pain during intercourse, or changes in urination habits. The American College Of Obstetricians and Gynecologists. If youve been sitting, get up and walk around, the ACOG recommends. If left untreated, PID can potentially cause a life-threatening condition called sepsis, which requires immediate medical attention. Is the ketogenic diet right for autoimmune conditions? Some pain medications are not safe to take during pregnancy. If you are experiencing sudden pelvic pain on one side, accompanied by fever, lightheadedness, or difficulty breathing, seek immediate medical attention. However, if the pain is severe and is accompanied by other symptoms such as vaginal bleeding, see your doctor as this could indicate a ruptured ovarian cyst. 2023 Dotdash Media, Inc. All rights reserved, Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Unlike IBS, IBD is often accompanied by more severe symptoms, such as fatigue, joint pain, blood in the stool, malnutrition, and weight loss. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. 2. Read on to learn more about the causes for uterus pain in early pregnancy and when to seek help. Anita Sadaty, MD, is a board-certified obstetrician-gynecologist, resident instructor at Northwell Health, and founder of Redefining Health Medical. Peritonitis is often caused by an infection from another organ, such as a burst appendix, although there are other underlying causes. Having the right people in your corner can relieve some pressure. Changes in Your Body During Pregnancy: Third Trimester. While theres no current treatment for IBS, reducing the frequency and severity of flare-ups can help decrease symptoms and improve overall quality of life. Find out what causes yellow semen and when you should see a doctor. If you have already been diagnosed with the condition, these symptoms may be a sign that your gestational diabetes isnt being managed properly.. Verywell Family's content is for informational and educational purposes only. In many cases, the cause of this type pain is related to your musculoskeletal. SELF may earn a portion of sales from products that are purchased through our site as part of our Affiliate Partnerships with retailers. Common discomforts during pregnancy. Always check with your doctor before trying these treatments, though. The loss of a pregnancy before 20 weeks is considered a miscarriage. Ankylosing Spondylitis Pain: Fact or Fiction, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364059/, https://www.acog.org/-/media/For-Patients/faq004.pdf, https://www.sciencedirect.com/science/article/pii/S1744388117303638, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001139.pub4/abstract, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058350/, https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/stages-pregnancy. doi:10.1136/bmjopen-2017-016434. 1. Some common causes of second trimester pains include: The round ligaments support the uterus and hold it in place. 1. Symptoms also include hard, dry stools, or fewer bowel movements than usual. The use of complementary and alternative medicine (CAM) for pregnancy related low back and/or pelvic girdle pain: An online survey. The pain should only last a few seconds or minutes, though it may return when you laugh or do certain movements like standing or bending down. Use of this site constitutes acceptance of our User Agreement and Privacy Policy and Cookie Statement and Your California Privacy Rights. Lightning crotch pain can feel a lot like round ligament pain but there are key differences: Other back pain or nerve-related pain can also feel similar, especially sciatica. Kidney stones can be composed of calcium, uric acid, struvite, or cystine, depending on the accumulating mineral. Levels of hormones in the body increase during pregnancy, which can slow down digestion and relax muscles in the bowels. Additionally, a little exercise can help with minor abdominal pains from constipation and gas, along with benefitting your mood and possibly even leading to better overall pregnancy outcomes like postpartum recovery time, the ACOG explains. We explain this symptom and the possible reasons for your discomfort. If you experience any of the above symptoms contact your healthcare provider immediately. As you try to adjust to your growing body by shifting your posture, that back pain might show up in response. Exercise, Recreational and occupational issues, and intimate relationships in pregnancy. Pelvic floor dysfunction can lead to constipation, urinary incontinence, or even pain during intercourse. Braxton-Hicks contractions may start anytime in the second trimester of pregnancy. Body changes and discomforts. If it lasts more than a few seconds, be sure to tell your doctor as it could signal something more serious. That sudden, sharp vaginal or pelvic pain you may feel late in pregnancy is called Lightning Crotch. During pregnancy, the growing belly puts extra pressure on these ligaments, which causes them to stretch and become thin. The pressure on the nerves can cause sharp twinges of pain. People arent more likely to contract chlamydia during pregnancy. All rights reserved. Surprisingly, besides pregnancy complications, appendicitis is the most common reason for emergency surgery during pregnancy, Dr. Clark tells SELF. IC pain often affects the lower pelvic region and flare-ups can range from dull cramps to sharp, stabbing pains. Having to cancel plans sometimes doesnt make you a bad friend. Restless legs syndrome and pregnancy: A review. transcutaneous electrical nerve stimulation (TENS), niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults, niddk.nih.gov/health-information/urologic-diseases/kidney-stones/definition-facts, niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome#treatments, ncbi.nlm.nih.gov/pubmedhealth/PMH0072600/, womenshealth.gov/a-z-topics/ovarian-cysts, fascrs.org/patients/disease-condition/pelvic-floor-dysfunction-expanded-version, womenshealth.gov/a-z-topics/pelvic-inflammatory-disease, nhs.uk/pregnancy/related-conditions/common-symptoms/stomach-pain/, hopkinsmedicine.org/health/conditions-and-diseases/peritonitis, What Causes Pelvic Pain in Males and How to Treat It, Pelvic Pain When Walking: 9 Common Causes, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, What Can Cause a Protruding Tailbone, and Whether It Should Be Treated, K-Y Duration Spray: Effectiveness, Pricing, and Customer Reviews, You Cant Enlarge Your Penis with Olive Oil and Onion Heres Why. It is also best to speak to a doctor or midwife if symptoms of lightning crotch occur with other signs of labor. Lightning crotch refers to a shooting pain in the crotch. The FDA Just Approved a Drug to Treat Hot FlashesHeres What to Know. You are also more vulnerable to exercise-related back injuries when you are pregnant. With endometriosis, this tissue can grow anywhere within the pelvic region, including the ovaries, fallopian tubes, and nearby organs. Although this condition is rarely life threatening, early treatment can greatly improve overall quality of life. Cleveland Clinic. Meralgia paresthetica results from pressure on the lateral femoral cutaneous nerve (LFCN), which is a nerve on the front and side of your thigh. It is always best to see a doctor if the pain does not improve or otherwise causes concern. People claim its helped them stop snoring and droolingheres what experts think. Ad Choices, These Are the 4 Pregnancy Pains You Shouldnt Ignore. Try a warm bath or massage to relax your muscles and joints. These types of sensations are not only common but very normal. Change positions in an effort to get baby off your nerves (literally) so stand up if youre lying down or sitting, or sit down if youve been standing. 2023 Healthline Media LLC. IBS is generally characterized as diarrhea predominant (IBS-D), constipation predominant (IBS-C), or mixed (IBS-M). Stay active and take plenty of desk breaks. In some instances, pain during the second trimester is a sign of something more serious. The pain comes on suddenly and can stop someone in their tracks. (n.d.). Copyright document.write(new Date().getFullYear()); American Pregnancy Association Web Design by Edesen, Prenatal vitamins consist of a variety of vitamins and minerals to help your baby get the nutrients that are essential, Paternity leave is the time a father or partner takes off from work after the birth or adoption of their, Many dads feel unneeded or left out of the relationship when they see how close Mom and Baby are , Establishing Paternity with Paternity Tests, Can I get pregnant ifand other questions about conception, Products & Tests to Support Your Pregnancy, Supplements and Medications for a Healthy Pregnancy, Sharp, shooting pain in the vagina or pelvic area that lasts only for a moment, Stinging or a pins-and-needles sensation in the same region, Brief but intense pelvic pain thats stronger and shorter than menstrual cramps. Dr. Jones recommends staying hydrated and eating a well-balanced diet to support your overall health during pregnancy. Back Pain During Pregnancy. If the pain is mild and goes away on its own, its likely nothing to worry about. What causes lightning pain when you're pregnant? It is essential to see a doctor if sharp, shooting pains occur in the crotch alongside other symptoms, such as vaginal bleeding or fever. In some cases, sharp, stabbing pains in the pelvis can indicate a more serious condition that requires immediate medical attention. You will gain weight and your body will grow to accommodate your new baby. Hypermobility Syndromes Association. (n.d.). (n.d.). Pregnancy causes a wide range of physical and emotional symptoms. Iron-deficiency anemia during pregnancy can cause restless leg syndrome, which may be accompanied by tingling, or a creepy-crawly feeling in the legs.
Some aches and pains are NBDothers deserve medical attention. Endometriosis has no cure, but you can use home remedies to help manage your symptoms. Belly Bands: What to Know About These Pregnancy Support Devices, Leg Cramps During Pregnancy: Causes, Symptoms, Treatment, Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: A prospective study, How to Handle Sciatica During Your Pregnancy, Changes in Your Body During Pregnancy: Third Trimester, Musculoskeletal pain and symptoms in pregnancy: a descriptive study, Who develops carpal tunnel syndrome during pregnancy: An analysis of obesity, gestational weight gain, and parity, Hypermobile Ehlers-Danlos syndrome and pregnancy, The effects of vitamin B12 supplementation in pregnancy and postpartum on growth and neurodevelopment in early childhood: Study Protocol for a Randomized Placebo Controlled Trial, An uptick in symptoms upon waking up, in the middle of the night, or when performing certain movements with your body, Feels like a pins and needles, a loss of sensation, or a radiating burning or tingling that is accompanied by pain, Presents toward the middle or end of pregnancy, as weight gain and fluid retention increase, Burning sensations in the hand, wrist, and arm, Pins and needles in the fingers and hands, Numbness in your fingers, especially the thumb, index, and middle fingers, Radiating pain in your shoulders, neck, and arm, Hormones such as relaxin that cause your ligaments to loosen, Pressure from your growing uterus and compressed organs, Sensations on one side of the body, but sometimes affects both sides, Symptoms that manifest in the lower back, hips, buttocks, and travel down the leg, Tingling sensations, numbness, and muscle weakness, Aching and soreness in thigh that may radiate to the outer knee, Numbness and burning sensations are also possible, Sensations like a stabbing feeling in the thigh region, Symptoms that are usually confined to one leg (thought sometimes the buttocks area is involved as well), Application of ice packs to reduce swelling, Use of a wrist brace or splint to keep your wrist in a neutral position, Sleep on the side of your body that is not affected. Sharp, stabbing, or chronic pain along with symptoms like bleeding, shortness of breath, or fever or chills likely requires emergency medical care. Normally, bowels contract to push waste along and out. Follicular ovarian cysts can develop before the follicle releases an egg, while corpus luteum cysts can develop after an egg is released. Despite the fact that sharp pain can be the result of normal pregnancy change, there are some warning signs that you need to watch out for in case the sharp pain is the result of a complication. For constipation, eat plenty of fiber-rich foods. Treatment for pudendal neuralgia may include different types of medications, physical therapy, lifestyle changes, and in some cases, surgery.