Balance Problems Explained: Causes and Treatments

By Jennifer Nadel, MD
Medically reviewed checkmarkMedically reviewed
July 25, 2022

Having a great balance is an important aspect of health, as being off-balance can be detrimental to your safety.

Your body’s ability to maintain balance depends on several systems, such as your eyes, muscles, bones, inner ear, blood vessels, nerves, and heart.

Feeling dizzy or that the room is spinning can happen whether you are lying down, sitting, or standing.

Other balance problems can feel like being lightheaded or unsteady.  

Read on to learn more about what can cause problems with balance, what balance problems feel like, and what treatments are available. 

What Do Balance Problems Feel Like?

Balance problems are one of the most common reasons older adults see their medical provider. 

Vertigo is a balance problem that feels like you or things are spinning around. 

Other balance problems can feel like:

  • Falling or feeling like you are going to fall
  • Staggering when walking
  • Blurred vision
  • Confusion or disorientation
  • Feeling lightheaded, faint, or like you are floating
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Causes

In America, about 15% of adults experience dizziness or balance problems.

Several health conditions or medications can be the cause.

A person’s ability to perform daily activities is greatly affected by balance disorders and can cause emotional and psychological hardship. 

Read on to learn more about what can cause balance disorders. 

Dehydration 

Dehydration is when your body has lost too many fluids.

Sickness such as vomiting or diarrhea, sweating, fever, or not drinking enough can be the cause.

Symptoms include:

  • Feeling thirsty
  • Dry mouth
  • Dark-colored urine
  • Not urinating very much
  • Dry skin
  • Dizziness
  • Feeling tired

Inner Ear Disorders

The inner ear contains loop-shaped canals that contain fine, hair-like sensors and fluid that help keep you balanced.

Sensory hair cells at the base of the canals have tiny particles that help monitor your head’s position in relation to gravity and linear movement.

For example, moving forward or backward in a car and up and down in an elevator. 

Any problems with the fluids or hair-like sensors (e.g., an ear infection, labyrinthitis, or benign positional vertigo) can cause dizziness or balance problems. 

Meniere’s Disease

An inner ear disorder called Meniere’s disease can cause a roaring sound in your ear called tinnitus, extreme dizziness, hearing loss that comes and goes, and ear pain.

The dizziness attacks can come on suddenly and sometimes cause people to fall.

The episodes can happen every once in a while, or a person may have many attacks close together for several days. 

The cause is not known, but doctors think it has something to do with the level of fluid or the mixing of fluids in the inner ear. 

Blood Pressure Problems

When a person has low blood pressure, also called hypotension, it means the brain and other organs are not getting enough blood flow. 

Orthostatic hypotension is when a person feels dizzy after a sudden change in body position, usually moving from sitting to standing.

The dizzy spell usually lasts only a few seconds or minutes.

It can be caused by dehydration, Parkinson’s, or other problems.

Neurally mediated hypotension (NMH) is more common in children and young adults.

It is a loss of balance from getting dizzy after standing for a long time.

Children usually outgrow this condition. 

Severe hypotension can be caused by severe infection, heart attack, sudden loss of blood, severe traumatic injury, or a severe allergic reaction.  

High blood pressure, also called hypertension, typically has no symptoms.

However, some medications to treat high blood pressure can cause a person to feel dizzy. 

To learn more about high blood pressure, click here. 

Low Blood Sugar

Your blood sugar naturally goes up and down throughout the day.

When it drops below 70mg/dl, it’s called hypoglycemia, or low blood sugar.

When it gets to that level, it’s important to take quick action to bring it back to normal. 

People who most commonly experience low blood sugar are people with diabetes.

Other causes can be not eating enough, not eating a balanced diet, not eating enough before exercise, hot and humid weather, and high altitude.

Symptoms of low blood sugar include:

  • Shaking
  • Sweating
  • Racing heart rate
  • Feeling nervous or anxious
  • Hunger
  • Confusion 
  • Dizziness

If you have diabetes, it will help to learn more about managing your blood sugar

Motion Sickness

Motion sickness is brought on when your brain senses movement from signals sent by your inner ears, eyes, muscles, and joints.

When the signals don’t match, it can cause nausea, vomiting, and dizziness. 

Anyone can get motion sickness, but it is most common in pregnant people and children.

To help prevent it, when on transit, try sitting in the front seat of the car, upper deck of a boat, and the wing area of the plane.

Don’t try to read or look at something in the vehicle but keep your eyes looking out into the distance. 

Head Injury

A head injury such as a concussion is a common cause of dizziness.

Symptoms can start slowly and can be different for every person. 

They can include physical problems such as balance issues, feeling tired, nausea and vomiting, and headaches.

Brain function problems include trouble with memory or concentration, feeling foggy or groggy, and trouble thinking clearly.

Social or emotional symptoms can include feeling more anxious, irritable, emotional, or sad. 

Poor Blood Circulation

When the brain is not getting enough blood flow, balance problems can start.

There are two main arteries that supply the back of the brain with blood, and these areas are needed to keep a person alive.

These areas are responsible for heart rate, breathing, swallowing, vision, and balance. 

Conditions that can slow or stop blood flow to the back of the brain include:

  • Smoking
  • High blood pressure
  • Diabetes
  • High cholesterol
  • Blood clots
  • Problems of the spine in the neck
  • Blood vessel inflammation

Common symptoms of poor blood flow to the brain include:

  • Slurred speech
  • Trouble swallowing
  • Vision loss or double vision
  • Tingling or numbness on the head or face
  • Sudden falls
  • Vertigo
  • Memory loss

Nervous System Diseases

Multiple sclerosis (MS) is an autoimmune disorder that affects the brain and spine.

It’s caused by the nerve’s protective cover being attacked and destroyed by the body’s immune system.

This prevents nerve signals from being able to travel through the nervous system in the damaged areas.

MS has many symptoms related to where the damage is occurring.

One of the symptoms is dizziness. 

Other disorders of the nervous system that can cause balance problems include:

Certain Medications

Some medications are toxic to the inner ear and, when taken, can cause dizziness.

These medications include:

  • Aminoglycoside antibiotics (gentamicin, neomycin)
  • Cisplatin (a chemotherapy medication)
  • Diuretics (water pills)
  • Aspirin

Other medications that can cause dizziness as a side effect include:

Risk Factors

Risk factors include: 

  • Being on medications that can cause dizziness
  • Dehydration
  • Having an inner ear problem
  • Recovering from a head injury
  • Having high or low blood pressure
  • Traveling on a boat or ship
  • Recent head injury
  • Diabetes
  • Poor blood circulation

Diagnosis

Your medical provider will ask you questions about your symptoms and review your medical history and current medications to diagnose what is going on.

The physical exam will include assessing your vital signs, such as your blood pressure, heart rate, and oxygen level.

Your provider will also test your muscle strengths, eyes, and ears and ask you to walk around to assess your gait. 

After your initial assessment, your provider may order further testing. 

Blood Work

Blood work can check: 

  • Electrolytes levels
  • Kidney function
  • Dehydration
  • Blood count
  • Blood sugar level

Urine Tests

Urine tests can check for infection, dehydration, and urine sugar level. 

Balance Test

A balance test is a group of tests that checks for what can be causing balance problems.

You may have one or more of the following tests:

  • Electronystagmography (ENG) and videonystagmography (VNG) test: These tests measure your eye movements while you watch light patterns. Warm and cool water or air is then put into your ears which should cause specific eye movements. If the eyes do not react correctly, it means there may be damage to the inner ear nerves. 
  • Rotary test (or rotary chair test): This test also measures your eye movements. Wearing special goggles that record your eye movements, you sit in a computer-controlled chair that slowly moves back and forth and in a circle. 
  • Posturography (computerized dynamic posturography (CDP)): This is a test that measures your ability to remain balanced while standing. Wearing a safety harness and standing barefoot on a platform, a landscape plays around you while the platform moves. 
  • Vestibular-evoked myogenic potentials (VEMP) test: This test measures how some of your muscles respond to sound to show if there is an inner ear problem. Reclining in a chair with earphones and sensor pads on certain muscles, clicks, and bursts of tones are played through the earphones, while you are asked to lift your head or eyes for short periods. 
  • Dix hallpike maneuver: This test can elicit vertigo symptoms and cause eye nystagmus.  This test can help differentiate the cause of vertigo.   During the test, the doctor will quickly move you from sitting to lying down positions and move your head in different directions. 

Hearing Tests

A hearing test can help determine if there is anything wrong with the nerves of your inner ear, which could be causing balance problems.

There are several different types of hearing tests.

They test how well you hear different tones, pitches, and volumes and how your ears respond in noisy versus quiet environments. 

Imaging

In some cases, imaging of your brain is needed.

Images done with a CT scan or MRI can help your healthcare team find the underlying cause. 

Treatment

The first thing your medical provider will want to do is determine what is causing you to feel unsteady.

Then your provider can treat the condition, suggest medications that may help, or refer you to a specialist. 

For dizziness related to dehydration alone, increasing fluid intake will decrease your symptoms.  

For inner ear problems, you may need antibiotics to treat an infection, or there are some maneuvers the medical provider can perform which can fix inner ear problems and symptoms. 

Getting blood pressure under control and learning how to manage blood sugar is important if this is your problem. 

If you tend to get motion sickness easily, talk with your medical professional about medications you can take beforehand to keep you from getting sick. 

Dizziness from a head trauma usually goes away over time as the injury heals. 

For circulation and nervous system conditions, your medical provider can go over what treatments are available. 

Prevention

To prevent balance issues, learn what makes you feel unbalanced and how to manage that condition. 

Living a healthy lifestyle that includes regular exercise and eating a balanced diet can help prevent many of these issues from arising. 

If you are currently having balance issues, it is important you learn what you need to do to prevent a fall.

Talk with your medical provider about tips and what tools are available to help keep you safe. 

Having balance problems? Chat with a provider through K Health.
Get Started

When to See a Medical Professional

If you believe you are having a dizziness or balance disorder, it’s important to talk with your medical provider about it.

Being off-balance is unsafe for anyone and finding the underlying cause and treatment is important. 

How K Health Can Help

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Frequently Asked Questions

What are the main causes of balance problems?
Numerous conditions can cause balance problems. Dehydration, low blood sugar, abnormal blood pressure, strokes, head injuries, and disorders can all be causes of balance problems.
What diseases affect your balance?
Meniere’s disease causes dizziness, possibly because of the fluids in the inner ear being unbalanced. There is also low blood pressure (hypotension), low blood sugar (hypoglycemia), Parkinson’s disease, and multiple sclerosis, which can cause problems.
How do you fix balance problems?
First, you need to determine the underlying causes of your balance issues. Once that has been determined, your treatment plan will follow.
What deficiency causes balance problems?
Being deficient in vitamin D, vitamin B12, iron, and primary coenzyme Q10 can affect your balance.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Jennifer Nadel, MD

Dr. Jennifer Nadel is a board certified emergency medicine physician and received her medical degree from the George Washington University School of Medicine. She has worked in varied practice environments, including academic urban level-one trauma centers, community hospital emergency departments, skilled nursing facilities, telemedicine, EMS medical control, and flight medicine.