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[7] Increased pressure within the abdomen caused by: Heavy lifting or bending over Frequent or hard coughing Hard sneezing Violent vomiting Straining during defecation (i.e., the Valsalva maneuver) Obesity and age-related changes to the diaphragm are also general risk factors

References Vitamin B12 Product Label Cyanocobalamin injection [package insert]

These symptoms might be more than just stress or a busy lifestylethey could point to a vitamin B12 deficiency

VEGF (vascular endothelial growth factor) induction was reported in certain models, without the transcriptional mechanism being fully dissected