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Internal Medicine Doctors of
Mill Basin & Bergen Beach, Brooklyn

6301 Mill Lane (Corner of East 63rd) in Mill Basin (11234)


Dr. Bella Zimilevich

Dr. Bella Zimilevich, MD
Primary Care Doctor

Dr. Bella Zimilevich

Dr. Anatoly Pisman, M.D
Physical Medicine & Rehabilitation

Dr. Bella Zimilevich

Dr. Alexander Shapsis, M.D

Gastrointestinal Health


Inflammatory Bowel Disease (Crohn’s disease, Ulcerative Colitis)

Posted by on October 6th, 2013

Dr. Bella Zimilevich, MD

The symptoms of inflammatory bowel disease can be debilitating and can negatively impact quality of life. If you have inflammatory bowel disease, you will need a physician who can coordinate your care with a gastroenterologist and work with you to manage your condition, so that you can live as symptom free as possible!

-Dr. Zimilevich, MD

What is inflammatory bowel disease (IBD)?

In inflammatory bowel disease, parts of the bowel become inflamed. There are two main types of IBD:

  • ulcerative colitis- ulcerative colitis usually develops slowly over time and involves continuous segments of the rectum and colon (large intestine). Usually the innermost lining is affected.
  • Crohn’s disease- in Crohn’s disease, inflammation may occur anywhere in the small and large intestines. Inflammation may involve deep layers of the bowel

What are the symptoms of inflammatory bowel disease?

Symptoms are a little different for ulcerative colitis and Crohn’s disease, although they may share some symptom:

  • ulcerative colitis- symptoms of ulcerative colitis may vary according to the areas of the large bowel affected. Symptoms are mildest when only the rectum is involved, causing rectal pain, bleeding and a sense of urgency surrounding bowel movements (ulcerative proctitis). Sometimes rectal bleeding is the only symptom experienced. When greater segments of the colon is involved, symptoms may include bloody diarrhea, abdominal pain and cramping, tiredness and unintended weight loss. Bouts of illness may alternate with periods of wellness (remission).
  • Crohn’s disease- in addition to abdominal pain and cramping, diarrhea, blood in the stool, decreased appetite and malnutrition due to the inability of diseased bowel to absorb nutrients (remember, the small bowel can be involved in Crohn’s, which is where nutrients are absorbed), Crohn’s is a systemic disease that can affect other body systems. Individuals with Crohn’s may also have fever, rashes, fatigue, arthritis and inflammation affecting the eyes. As with ulcerative colitis, people with Crohn’s disease may experience periods of remission when their symptoms disappear.

What causes inflammatory bowel disease?

No one really knows. Researchers believe that both disorders may be an autoimmune response. It is also possible that heredity may play a role, as people who have family members with IBD are more likely to develop one of these disorders.

Risk factors for IBD include:

  • age- most people with IBD are under the age of 30, but IBD develops later in some individuals (50s and 60s)
  • cigarette smoking- smoking can make your symptoms worse and increases the risk of complications
  • NSAID use- using non-steroidal antiinflammatory agents, such as ibuprofen or Naproxen, can cause ulceration in the GI tract and may worsen IBD. Tylenol is safe to use.
  • ethnicity- Caucasians and people of Jewish descent have a higher prevalence of IBD
  • family history- as mentioned, having someone in your family diagnosed with the condition raises your risk

 What can I expect when I come to see you?

When you come in to see me with gastrointestinal symptoms that suggest inflammatory bowel disease, I will need to know a little about your past medical history, your family medical history and what drugs you are currently taking, if any.

Next, I’ll ask you about your symptoms. I may ask you about:

  • pain- where is it located? does it come and go? is the pain related to bowel movements? on how many days of the past month did you experience abdominal pain?
  • bowel habits- are you experiencing diarrhea? constipation? how often do your bowels move and what is the consistency of your bowel movements?
  • blood in the stool- is there fresh blood only when you wipe, is the blood mixed in the stool, or is there blood in the toilet water?
  • weight loss- have you lost weight unintentionally? how much weight do you estimate you have lost?
  • fever- have you been experiencing any fever?
  • other symptoms- have you experienced other symptoms, such as rash, joint pain or eye inflammation?

Although these questions may make you squeamish, remember that the more information I have, the better and more accurately I can diagnose you. Please don’t feel embarrassed- I am a doctor and chances are I have heard it before!

I will need to examine you and may ask you to change into a gown. I may weigh you to get a baseline weight. I will listen to your abdomen for abnormal bowel signs. I will also gently press your abdomen in several places to see if I can feel any abnormal masses and to determine what areas are tender when I press on them.

I will likely order diagnostic tests, such as blood work to check for anemia and inflammation, as well as malnutrition if you have lost weight. I may order an abdominal x-ray. If I feel your symptoms are consistent with inflammatory bowel disease, I may order a colonoscopy, which is a test that uses a scope to view the inside of the bowel (you are sedated throughout the exam). If necessary, I will refer you to a gastroenterologist.

If you are suffering with symptoms that may be IBD, you need to come in and see me as soon as possible. The longer you wait, the more damage that may be done to your intestines. Don’t delay- make an appointment today.

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Medical Treatment for Abdominal Pain

Posted by on October 6th, 2013

Dr. Bella Zimilevich, MD

“Abdominal pain can have numerous causes. It can be difficult even for doctors to differentiate between serious and benign causes of abdominal pain. The abdomen contains many organs that can potentially cause problems. For this reason, it is always best to err on the side of caution. Most of the time abdominal pain is not serious, but when it is serious it is VERY serious. If you are experiencing abdominal pain, come in and see me.”

-Dr. Zimilevich, MD

What is abdominal pain?

Abdominal pain is any pain that occurs below the xiphoid process (the bottom tip of your sternum or breastbone) and above the pubic bone. It may be dull, sharp, constant, intermittent, stabbing or aching in nature. It may occur on its own or may be accompanied by other signs and symptoms, such as nausea and vomiting or fever. These accompanying signs and symptoms can provide clues as to what may be causing the problem.

What causes abdominal pain?

Abdominal pain can be caused by many issues affecting the organs found in the abdominal cavity, including:

  • gynecological problems- in women pain may arise from problems affecting the uterus, ovaries or fallopian tubes
  • the stomach- stomach viruses, food poisoning and  ulcers are common problems affecting the stomach. Invariably, appetite will be affected. Nausea and vomiting may also occur. Pain in the stomach is often referred to as burning or gnawing pain. Chronic issues affecting the stomach may result in weight loss.
  • the intestines- intestinal illnesses can cause a lot of discomfort. Pain may be constant or intermittent and may be sharp or dull. There may be accompanying signs and symptoms such as nausea, vomiting, blood in the stool, weight loss, rectal pain, inability to pass flatus (gas or wind) or fever. The location of the pain can also provide clues. Pain that is centered around the belly button is likely to be caused by a problem in the small bowel; intestinal pain arising from the large bowel may be felt all over as generalized tenderness. History and physical exam will provide other clues. Intestinal problems may be infectious (a viral or bacterial cause such as food poisoning), may be caused by inflammatory bowel disease, adhesions or blockage of the bowel.
  • the appendix- the appendix is located in the right lower quadrant of the abdomen. Pain often begins around the belly button and may eventually move to the right lower side of the abdomen, midway between your hip bone and your belly button, known as McBurney’s point. If you have appendicitis, you will not have an appetite and you may be constipated. You may have a low-grade fever. Pain gradually worsens over time. Appendicitis is a surgical emergency. If you have symptoms of appendicitis, you should seek medical attention immediately.
  • the pancreas- pancreatitis (inflammation of the pancreas) causes severe pain that will be difficult to ignore. The pain occurs in the upper abdomen and may radiate through to the back. Pancreatitis may also cause nausea and a low-grade fever. People with pancreatitis feel very ill. Gall stones or alcohol may precipitate an attack of pancreatitis.
  • the gallbladder- gallstones or infection of the gallbladder can cause severe pain that is usually felt in the upper abdomen and may radiate to the back.  Gallstones may block the bile duct, causing intense pain that may occur after eating a heavy or fatty meal. The pain usually subsides within a few hours but may reoccur again. Nausea and vomiting may occur.
  • urinary tract problems- infection in the urinary tract (bladder or kidneys) may cause abdominal pain. Kidney infection or stones often cause severe pain that is felt in the flank area (just below the ribs and beside the spine on the affected side). Nausea and vomiting may occur. Fever will occur with infection. Testing the urine may reveal infection or blood in the urine.
  • diverticular disease- the colon may develop weakened areas of the muscular wall that bulge out, allowing waste to collect in these areas. When these pockets develop infection, symptoms will include lower left abdominal pain, fever and flu-like symptoms. Diverticulitis requires antibiotics.

These are some of the common problems that may cause abdominal pain- there are many more. As you can see, the many organs of the abdomen present a challenge to diagnosis!


What can I expect when I come in to see you?

When you come in to see me with abdominal pain, I will first ask you about your past medical history, including any surgeries you may have had. I will also ask about family history and medications you are taking.

I will ask you about your symptoms. When did they start? Where is the pain? What is the nature of the pain (i.e. sharp or dull)? Is the pain constant, or does it come and go? Does the pain radiate (move) to other areas? What other symptoms are you experiencing (i.e. diarrhea, vomiting, fever)?

Once I have a handle on your symptoms, I will examine you, focusing on your abdomen. I will listen to your bowel sounds. I will also palpate (feel) your abdomen for areas of tenderness, swelling or masses. I will be paying attention to where your abdomen hurts the most. Once I have examined you and discussed your symptoms, I will likely order tests, which may include blood tests, an abdominal x-ray and urinalysis. I may order other tests as I see necessary.

Based on all of the information gathered, I will probably have a good idea as to what may be causing your abdominal pain and we can discuss what treatment is necessary to relieve your pain. If I cannot determine the source of your pain, I may refer you to a gastroenterologist.

If you are experiencing abdominal pain, make an appointment to see me. Some conditions that cause abdominal pain are benign, but others may be very serious and require immediate care. Make your appointment today.

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Irritable Bowel Syndrome (IBS)

Posted by on September 6th, 2013

Dr. Bella Zimilevich, MD

“Irritable bowel syndrome (IBS) is a condition causing abdominal discomfort and is a common reason for seeking medical care. If you suffer from abdominal pain and cramping combined with altered bowel habits (diarrhea, constipation or both), you should make an appointment to come in and see me so that we can determine if you have IBS. These symptoms are also common in other, more serious conditions so it is important to rule out other conditions as well”.

-Dr. Bella Zimilevich, MD

What is irritable bowel syndrome (IBS)?

IBS is a collection of symptoms caused by a change in how the bowel functions. It is not a disease; in other words, the structure of the bowel itself does not change. Functional disorders of the gastrointestinal tract cause real symptoms. Just because there is no actual damage to the gastrointestinal tract does NOT mean that your symptoms are not real- the symptoms of IBS are all too real and can be quite distressing for some. IBS causes alterations in bowel function, along with abdominal bloating and other symptoms. Women are affected more often than men, and the condition is diagnosed in younger people more often than in older people.

Types of IBS

IBS can be classified according to the predominant symptom:

  • IBS-C (IBS with constipation)- people with IBS-C experience constipation more often than diarrhea, although both may occur
  • IBS-D (IBS with diarrhea)- people with IBS-D experience diarrhea more often than constipation, although both may occur
  • Mixed IBS- people with Mixed IBS experience both diarrhea and constipation at least 25% of the time

IBS is usually diagnosed if you experience symptoms of abdominal pain at least 3 times a month that cannot be explained by another condition. Abdominal discomfort may be relieved by a bowel movement and may be associated with a change in your bowel movements.

What are the symptoms of IBS?

The primary symptoms of irritable bowel syndrome are abdominal discomfort and a change in bowel habits. Symptoms must occur more than 3 times a month to meet the criteria for IBS. Pain is associated with one of the following:

  • more frequent/less frequent bowel movements
  • stools that are harder than usual or more watery/loose than normal
  • relief with a bowel movement (pain goes away after a bowel movement)

You may also experience abdominal bloating (often worse after eating), the sensation of incomplete emptying of the bowel/rectum and mucousy (but never bloody) stools.

What causes IBS?

Researchers are not 100% sure what causes IBS. Stress may play a role- you may find that your symptoms are worse during times of physical or emotional/mental stress. Overgrowth of bacteria in the gut has also been blamed for IBS. Poor motility (the ability of your intestines to move food along the intestines) has been postulated as causing IBS. Food sensitivity and hormones (IBS is often worse during menstruation) are other possible causes.

What can I expect when I come to see you?

When you come to see me and you are worried about IBS, I’ll begin by asking you a lot of questions. I’ll ask about:

  • past medical history, including abdominal surgeries
  • medications you are taking
  • allergies to foods or medications
  • family history of gastrointestinal disease
  • whether you have had any fever, blood in your stool, weight loss or other symptoms suggestive of colon cancer or an intestinal infection
  • whether you have traveled recently

I will need to know how long you have had symptoms, when your symptoms started and how often you experience symptoms. I will also ask about your bowel habits (how often you have a bowel movement). If you are a woman I may also ask about your menstrual pattern and whether symptoms are associated with your period.

Once I have gathered all of this information, I will examine your abdomen to feel for any tender areas or masses. I will listen for bowel sounds. If necessary, I may order diagnostic tests, such as blood work to check for anemia or infection or stool studies to check for bacteria or parasites in your stool. I may order other tests such as an abdominal x-ray or abdominal ultrasound as necessary. Quite often the diagnosis of IBS can be made without the need for a lot of tests, but it is also important to rule out other serious causes of your symptoms such as bowel cancer or inflammatory bowel disease.

Once I have all of the information I need, I will be able to tell you what I think may be causing your symptoms. If I am unable to determine the cause of your symptoms, I will refer you to a specialist (a gastroenterologist). This is rarely necessary.

What is the treatment for IBS?

Treatment for IBS must be individualized. If you have diarrhea, treatment might include medications to bulk up your stool or slow the transit time through your bowel. If you have constipation, increasing fluid intake and dietary changes can be helpful. Using a probiotic can also be helpful, as can avoiding certain foods. If I feel that you have IBS, we’ll have a lot to discuss as we decide on treatment based on your unique symptoms.

If you have symptoms of IBS, it’s important that you come in and see me. The symptoms of IBS are similar to the symptoms of other serious conditions that should be ruled out. IBS causes real and distressing symptoms that can be treated, so make your appointment today.

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Medical Help For Vomiting (Nausea, Upset Stomach)

Posted by on September 3rd, 2013

Dr. Bella Zimilevich, MD

“Almost everyone vomits from time to time. Brief episodes of vomiting may be due to a virus or a dietary indiscretion. For some people, vomiting occurs as part of a pattern of illness. If you are vomiting frequently or have other warning signs of a serious illness, it’s important that you seek medical care.”

-Dr. Zimilevich, MD

 What is the difference between nausea and vomiting?

Nausea is the sensation that you are about to vomit. It may occur by itself or may actually be followed by vomiting, which is the forceful ejection of the stomach contents up through the esophagus and out your mouth. Both nausea and vomiting are extremely unpleasant sensations that most people would just as soon avoid!

Causes of nausea and vomiting

There are many conditions that can make us feel nauseated or cause us to vomit. The following is only a partial list:

  • stomach or intestinal infection with a virus or bacteria– we’ve all experienced “the stomach flu”, which often causes nausea, vomiting and diarrhea for a day or two and usually subsides on its own without treatment. Viral gastrointestinal illnesses are extremely contagious and can be passed from person to person very easily. Bacterial illness affecting the GI tract may result from eating contaminated food (“food poisoning”) and can make you feel very ill. Food poisoning often requires medical treatment.
  • acid reflux and GERD (gastroesophageal reflux disease)- in GERD, patients sometimes vomit because the flap of tissue between the stomach and esophagus which prevents food from “refluxing” from the stomach back up into the esophagus is incompetent
  • pain– patients will sometimes become nauseated when they are in pain and may actually vomit when pain is severe (think kidney stones and migraine headaches)
  • food intolerance/allergies– some people become nauseated when they eat foods that they are sensitive or allergic to, or foods that they lack the proper enzyme to digest
  • medications– many medications, such as antibiotics and opioids, have nausea as a side effect (which doesn’t necessarily mean that the person is allergic to the medication); nausea due to medication may pass as your body adjusts to the medication
  • motion sickness– some people become nauseated and may vomit when they travel by car or boat
  • morning sickness- some women experience nausea and vomiting during pregnancy, thought to be due to hormonal changes
  • ulcers– some people with gastric or duodenal ulcers may experience nausea/vomiting
  • bowel obstruction– nausea and vomiting are common symptoms of bowel obstruction, more typically with small bowel obstructions
  • cancer or cancer treatment– certain types of cancer may cause nausea and vomiting (i.e., colon cancer resulting in bowel obstruction); chemotherapy, radiation and other cancer treatments may also cause nausea and vomiting


How do I know if I need to be seen by a doctor?

As can be seen, nausea and vomiting may be caused by a number of conditions, some fairly benign and others far more serious. It can be difficult to determine when you should come in to be assessed. The following are some guidelines:

  • dehydration- if you are unable to keep any fluids down, or you are vomiting very frequently and/or experiencing diarrhea, you may become dehydrated. If you are dehydrated, you may feel weak, dizzy and very thirsty with a dry mouth. You may urinate less often, your urine may appear darker than normal and your eyes may appear sunken in your eye sockets. Even a simple virus can cause significant dehydration that can be dangerous, especially if you have an underlying health condition. If you have been vomiting for longer than a day, or have been unable to keep any fluids down for longer than 12 hours, it may be time to seek help.
  • abdominal pain– if you are experiencing severe abdominal pain along with your nausea and vomiting, this may be a sign of a more serious condition such as a bowel obstruction, especially if you are not passing flatus (gas) and have not had a bowel movement in some time.
  • urination– if you are urinating infrequently, your urine is very dark in color or you have not voided in longer than 8 hours, you are likely dehydrated.
  • vomiting blood– if you are vomiting blood, or dark material resembling coffee grounds, you should seek emergency care
  • fever– you may experience a low-grade fever with viral gastrointestinal illness; if your fever is over 101 degrees Fahrenheit you should seek medical care
  • weight loss– if you have been nauseated and/or vomiting for a prolonged period of time you may lose weight, which could signify a serious problem.

These are guidelines only. If you are feeling very sick, you should seek medical care- you do not need to have any or all of these symptoms!

What can I expect when I come in with nausea or vomiting?

When you come in to see me complaining of nausea and vomiting I will first need to ask you about your past medical history, any medications you are taking  and whether you have any allergies to foods or medications.

Once I have gathered this information, I’ll ask you to describe your current symptoms: when they started, how many times you have vomited and whether you are also experiencing diarrhea or other symptoms such as abdominal pain or fever. I will also ask whether you have taken any over-the-counter remedies for nausea and vomiting and whether they were helpful. I’ll ask you to estimate your fluid and food intake. Once I have gathered all of the pertinent information I will examine you, focusing on signs of dehydration and your abdomen. I will listen to your abdomen and feel for any masses or tender areas that may provide clues as to the cause of your symptoms.

If necessary, I will order lab work such as a CBC and electrolytes to help me determine your level of dehydration and whether an  infection might be causing your symptoms. If you are also suffering from diarrhea, I might order a stool culture to look for bacteria in your stool. I may also order an abdominal x-ray if I feel it is needed based on your symptoms.

Once I have gathered the information I need we’ll sit down and discuss what I think is causing your symptoms of nausea and vomiting. Together we’ll decide on the best course of action.

If you have been experiencing nausea and vomiting for longer than a day or two, especially if you are unable to keep fluids down, make an appointment to come in and see me. Whether it takes one visit or more, we’ll figure out what the problem is and get you feeling better!

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Medical Treatment Options For Diarrhea (Watery or Loose Stools)

Posted by on August 16th, 2013

Dr. Bella Zimilevich, MD

“It may not be a pleasant subject to discuss , but diarrhea is a common problem that is sure to affect everyone at one time or another. Numerous health conditions can cause diarrhea. Most of the time, diarrhea is caused by a dietary indiscretion or a viral illness and is short-lived, but for some diarrhea can be a symptom of a more serious condition. If your diarrhea last longer than a few days, you should make an appointment to come in and see me”.

-Dr. Zimilevich, MD

What is diarrhea?

Like constipation, diarrhea may mean different things to different people. The frequency and consistency of bowel movements is highly individual. Diarrhea can be described as stools that are more frequent and looser/more watery in consistency.

What symptoms might occur along with diarrhea?

Along with frequent and loose/watery stools, you might also have:

  • abdominal pain/cramping
  • bloating
  • low-grade fever (if your diarrhea is caused by a virus)
  • nausea/vomiting

What causes diarrhea?

Diarrhea is the result of increased bowel transit time- in other words, food and fluids pass too quickly through your bowel. When transit time is normal, your body pulls water from your bowels, leaving a semi-solid stool to be passed. When stool passes through so quickly that little water is absorbed, diarrhea is the result.

There are numerous conditions that can cause diarrhea, including:

  •  viral illness– we’ve all experienced viruses that cause diarrhea along with nausea and vomiting; these viruses generally cause illness for 1 to 3 days
  • bacterial illnesses- bacteria in water or food may cause diarrhea; you may also have fever, abdominal pain and blood in your stool
  • medication– antibiotics often cause diarrhea, as do many other medications (if you think your medication is causing diarrhea, you should schedule a visit)
  • irritable bowel syndrome (IBS)- IBS is a functional bowel disorder (meaning that nothing is wrong with the bowel structurally); IBS may cause diarrhea alone, constipation alone, or alternating constipation and diarrhea. Abdominal bloating is also a feature of this common disorder
  • lactose intolerance– people who lack the enzyme required to break down the sugar in milk may suffer from bloating, cramping and diarrhea after consuming dairy products
  • surgery- if you have had abdominal surgery, you may experience diarrhea transiently or permanently, depending on the procedure that was performed
  • celiac disease (gluten intolerance)– in this disorder, people are unable to digest gluten, which is found in many foods
  • Crohn’s disease/ilcerative colitis– these are inflammatory bowel disorders that can cause diarrhea, blood in the stool, abdominal pain and other symptoms
  • parasites– parasitic infections (often picked up while traveling) may cause diarrhea

These are just a few of the causes of diarrhea- there are many more.

How do I know if my diarrhea is serious?

It can be difficult to know when your diarrhea is bad enough that you should make an appointment to see me. Generally speaking, you should make an appointment if:

  • you have a high fever for more than a day
  • you are passing blood in your stool (may be bright red or tarry black stools)
  • you are dehydrated (you feel weak, dizzy, pass very little urine or your urine is dark, your pulse is fast or your mouth is very dry)
  • you have severe stomach/abdominal pain
  • you have had frequent diarrhea for more than 48 hours
  • you have an underlying health condition such as diabetes, heart disease or other serious illness

What can I expect when I come in?

When you come to see me with diarrhea, I will ask about your symptoms. I will need to know when your symptoms started, whether you have traveled, how frequently you are passing loose or watery stools and what other symptoms you are experiencing (i.e., vomiting, fever, abdominal pain). I will want to know about your past medical history if you are a new patient. I will also need to know if you have any allergies.

I will take your vital signs. Abnormal vital signs, such as low blood pressure and a rapid pulse, may tell me that you are dehydrated. I will need to examine you (you may need to change into a gown for the examination). I will listen you your abdomen and press gently so that I can determine if any area of your abdomen is tender when I press on it. I may also listen to your heart and lungs. I will look for signs of dehydration (dry mouth, sunken eyes).

Depending on my findings and your history, I may order diagnostic tests such as blood work, stool samples, and abdominal x-ray or other tests. I will tell you what I am ordering and why I am ordering a particular test. I will also discuss the results of any test with you, so that we can decide how best to treat you. Treatment will depend on what the problem is.

If you are experiencing diarrhea that has lasted more than a couple of days, especially if your diarrhea is associated with any of the serious signs and symptoms listed above, you should make an appointment to come in and see me as soon as possible. Although you may just have a viral illness, there are many conditions that have diarrhea as a feature.

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Medical Appointments For Constipation (Irregular Bowel Movements, Hard Stools)

Posted by on July 28th, 2013

Dr. Bella Zimilevich, MD “Constipation is an embarrassing topic for many people, although it is very common. It can cause abdominal discomfort, nausea and loss of appetite. If left untreated, severe constipation can lead to mechanical obstruction. If you suffer from frequent or chronic constipation, you want to be sure that there is not an underlying problem causing your constipation. Make an appointment to see me so that I can help you get your bowels back on the right track”. Dr. Zimilevich, MD

Constipation defined The definition of constipation varies from person to person. While some people may have a bowel movement every single day, others may go 2 or 3 days between bowel movements and feel just fine. Therefore, constipation can be defined as less than 3 stools (bowel movements) per week and/or difficulty passing stools. If you are going every day or two but have to strain to pass very hard stools, you are constipated!

What causes constipation? The list of conditions that can cause constipation is long. The following are some of the more common causes:

  • dehydration/not drinking enough fluids- when your body is low on fluids, your intestines will draw more fluid from stools (or add less water to stools), making them harder to pass
  • not enough fiber in your diet- many of us fail to eat enough fiber in our diets (women should consume about 21 to 25 grams of fiber; men should consume about 35 to 38 grams of fiber per day)
  • sedentary lifestyle- older people and people who do not get enough exercise are more likely to become constipated
  • medications- many medications can cause constipation, including narcotic pain medications, certain blood pressure medications, antidepressants and others
  • ignoring the urge to “go”/delaying the urge- sometimes we ignore the urge to have a bowel movement because it isn’t convenient (i.e., you’re too busy at work to stop what you are doing); ignoring the urge may lead to constipation
  • changes in routine/lifestyle- pregnancy, aging, travel and other changes in your regular routine can lead to constipation
  • laxative abuse- ironically, using laxatives too often can lead to a lazy bowel that won’t work well without more laxatives, thus creating a viscious cycle that can be difficult to break
  • specific medical conditions- stroke, diabetes, Multiple Sclerosis, Parkinson’s disease and other health conditions can affect bowel movements
  • bowel problems- diverticulosis, bowel obstruction and other bowel conditions may have constipation as one of the major symptoms
  • IBS- IBS is a functional bowel disorder that results in diarrhea, constipation or a combination of the two; IBS is a functional bowel disorder which is very common
  • hormonal disturbance- thyroid gland dysfunction and other disorders of the glands may cause constipation
  • spinal cord injury- many spinal cord injury patients suffer from constipation due to damage to nerves that innervate the bowel
  • hemorrhoids/anal fissures- painful rectal or anal conditions may cause constipation because these conditions are painful, and sufferers may be reluctant to have a bowel movement due to pain; in addition, anal sphincter muscles may spasm, making it difficult to have a bowel movement

What symptoms can be caused by constipation? As we discussed, passing fewer than 3 stools per week or passing hard stools/straining at stools are part and parcel of constipation. If you are constipated, you might also experience:

  • a sensation of stool in the rectum/rectal blockage
  • a sense of incomplete evacuation
  • bloating/cramping/abdominal discomfort
  • mild nausea

These symptoms are common in constipation. If you are frequently constipated, you should make an appointment to see me in the clinic. What symptoms might signal a more serious problem? If you are constipated and experience any of the following symptoms, you should come in as soon as possible to be assessed:

  • blood in your stool
  • weight loss
  • fever
  • vomiting
  • inability to pass flatus (gas)
  • severe abdominal pain
  • increasing abdominal girth (your abdomen seems to be growing steadily and you’re not pregnant)
  • thin, ribbon-like stools
  • pain in the rectum

These symptoms may signal a more serious problem, such as rectal or bowel cancer, inflammatory bowel disease or an infectious process.

What can I expect at my appointment? When you come to see me complaining of constipation, I’ll ask about your bowel habits. I will want to know how often you have a bowel movement, whether your stools are hard and whether you have to strain to pass stools. I’ll want to know if you have any medical problems that may be causing constipation. Please bring all of your medications (or a list of your medications) if I am seeing you for the first time so that I can rule out any medications as being to blame. I will also want to know how often you exercise and how may cups of water/how much fluid you drink in a day. I’ll want you to tell me about your typical diet so that we can determine whether lack of fiber may be contributing to the problem. You can estimate the number of servings of fruits, vegetables and grains you eat in a day. Better yet, keep a food diary for a week prior to your visit- this can really be helpful to me to help me pinpoint how you can improve your diet. I may want to examine your abdomen so that I can see if any areas are tender or any masses are present. Blood work, abdominal x-rays and other tests may rule out any serious problems, allowing me to focus on lifestyle remedies and possibly medications to treat your constipation.

Home remedies for constipation If you suffer from constipation, there are several things you can do to try to regulate your bowels:

  • increase the amount of water/fluids you are drinking
  • avoid caffeine and caffeinated beverages, as these may worsen constipation (caffeine is a mild diuretic)
  • try drinking a cup of warm water first thing in the morning (you can flavor with lemon if desired)
  • do not ignore the urge to have a bowel movement
  • increase your activity- walking is an excellent bowel stimulant
  • increase the amount of fiber you are eating

If none of the above remedies help you achieve more regular bowel habits and you are still constipated, make an appointment to come in and see me in the clinic. Together, we’ll get to the “bottom” of your constipation.

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What My Patients Should Know About Hemorrhoids (Piles)

Posted by on July 18th, 2013

Dr. Bella Zimilevich, MD

“Hemorrhoids are a common problem affecting millions of people. Although they can cause pain, discomfort and bleeding, many people are reluctant to seek medical care due to embarrassment. If you suffer from hemorrhoids, you should know that various treatments are available. If you have rectal pain or bleeding, you should come in to be seen to be certain that your symptoms are actually due to hemorrhoids and not another more serious problem”.

-Dr. Zimilevich, MD

What are hemorrhoids (piles)?

Just as you can get varicose veins from standing on your feet for too long, you can get hemorrhoids from activities that place undue pressure on the veins in the rectum. When veins swell within the rectum, they are called internal hemorrhoids. When the veins around the anal opening swell, they are known as external hemorrhoids. It is possible to have both types of hemorrhoids at the same time.

What causes hemorrhoids?

Piles are most common between the ages of 20 and 50- it is estimated that approximately 40% of people suffer from piles at some point in their life, so if you have them you can consider yourself to be in good company!

Hemorrhoids can be caused by:

  • weak veins- some people just naturally have weaker veins, which may predispose them to developing both piles and varicose veins
  • increased abdominal pressure- pregnancy, obesity, prolonged standing or sitting, frequent coughing or vomiting, and straining during bowel movements are all activities that can increase abdominal pressure and may lead to the formation of hemorrhoids
  • diet- people who eat a low fiber diet and/or a lot of processed foods may be at higher risk of developing hemorrhoids; this type of diet can cause constipation, and straining to have a bowel movement can lead to piles
  • inadequate fluid intake- not drinking enough fluids can cause stool to become hard and lead to straining during bowel movements; hard stools can also irritate hemorrhoids that are already present, causing them to swell even further or bleed
  • chronic diarrhea/constipation- spending a lot of time on the toilet can cause piles
  • age- as we age, the tissues supporting the veins in the anus/rectum can become weak

Are there different types of hemorrhoids?

As mentioned, piles may be found internally or externally.

  • internal hemorrhoids- these hemorrhoids are located inside the rectum and can’t be seen or felt. They are usually not painful because there aren’t a lot of nerves capable of transmitting pain in the rectum. Bleeding may be your only clue that you have internal hemorrhoids. Sometimes internal hemorrhoids become large enough that they protrude from the anus- these are known as prolapsed hemorrhoids. These can often be gently pushed back inside if they don’t recede on their own. When internal hemorrhoids prolapse they may be painful.
  • external hemorrhoids– these hemorrhoids lie just inside the anus and may be felt when you have a bowel movement. Because the anus is innervated with nerves, these hemorrhoids can be painful, particularly if they become thrombosed. A thrombosed hemorrhoid is an external hemorrhoid with a blood clot inside it. If you have a thrombosed hemorrhoid, you will likely be aware of it as these can be very painful. The pain may cause you to seek medical attention.


What are the symptoms of hemorrhoids?

If you have hemorrhoids, you may experience:

  • bleeding with bowel movements (this bleeding is painless- there may be bright red blood in the toilet bowel or on the toilet tissue)
  • discomfort/pain in the rectal area
  • swollen areas around the anus
  • a painful lump located near the anus
  • itching of the anal area
  • leakage of small amounts of stool

It can be difficult to judge the amount of blood loss when blood is present  in the toilet water. If you experience a change in bowel habits, pass tarry black or maroon stools or the blood is mixed within the stool, you should make an appointment to be seen immediately. Bleeding is most often caused by hemorrhoids, but it can also be caused by colon or rectal cancer or other gastrointestinal diseases. If you feel weak or dizzy and are bleeding from the rectum, you should seek care at the nearest emergency room.

What can I expect when I come in for my appointment?

If you know or suspect that you have hemorrhoids, especially if you are experiencing rectal bleeding, you should make an appointment to come in to see me. I will ask you what symptoms you have noticed, how long you have had the symptoms and what makes your symptoms better or worse. I may ask about your bowel habits (how often your bowels move), whether you have noticed a change in your bowel habits, what you typically eat and how much water or other fluids you normally drink. I will also ask if anyone in your family has ever had bowel or anal cancer. I may decide to examine you. If you have been experiencing a lot of bleeding or have been bleeding for a long time, I may decide to order blood work to ensure that you are not anemic (low in iron/red blood cells) from blood loss.

What is the treatment for hemorrhoids?

Treatment is dependent on whether your hemorrhoids are internal or external and how severe they are. Medicated ointments, creams and suppositories may be helpful to relieve discomfort, swelling and itching. You can also try warm baths for comfort. A high fiber diet and an  increase in fluid intake may help to prevent constipation. If your hemorrhoids are severe, I may decide to refer you to a specialist. Surgery is sometimes necessary, but there are also minimally invasive procedures that can be performed to treat hemorrhoids.

If you are experiencing rectal bleeding,  it is important to ensure that your bleeding is indeed due to hemorrhoids and not another more sinister condition. It is dangerous to assume that bleeding is due to hemorrhoids without ruling out a more serious problem. If you have hemorrhoids that are causing you discomfort or are experiencing rectal bleeding, make an appointment today.

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How I Diagnose and Treat Heartburn (Acid Reflux, Gastroesophageal Reflux Disease, GERD)

Posted by on July 6th, 2013

Dr. Bella Zimilevich, MD

“Heartburn can be miserable. You may think your heartburn is caused by eating something that doesn’t agree with you (and that may be part of the problem), but heartburn can also be a symptom of a more serious condition known as gastroesophageal reflux disease, or GERD. If you suffer from frequent heartburn, it’s important that you come and see me so that I can not only help you manage your symptoms, but so that I can rule out any serious problems that can have long-term consequences”.

-Dr. Zimilevich, MD

Understanding heartburn (acid reflux)

Between your mouth and your stomach lies your esophagus, and at the bottom of your esophagus, where it joins your stomach, is a valve called the lower esophageal sphincter (LES) that acts to prevent food and stomach contents from escaping (refluxing) up into the esophagus during digestion.

In some people, the LES doesn’t function as it should. Instead of staying tightly closed, the LES opens for no reason, or is unable to close properly, allowing stomach contents to travel up into the esophagus. When stomach acid comes in contact with the delicate lining of your esophagus, you experience symptoms of heartburn.

What are the symptoms of heartburn?

The classic symptom of heartburn is a sensation of burning or pain in the upper abdomen or chest. This discomfort can be so severe that it mimics the pain of a heart attack (and if you experience new or different chest pain, you should always see a doctor immediately). In addition to heartburn you may also experience:

  • difficulty swallowing
  • sore throat
  • hoarseness
  • coughing
  • vomiting
  • a sensation of having a lump in your throat
  • frequent need to clear your throat
  • burning sensation in the mouth
  • asthma symptoms

What is the difference between heartburn (reflux)  and GERD?

Occasional heartburn (gastroesophageal reflux) is common. Millions of people experience heartburn once in a while. However, if you experience heartburn more than two times a week, you may have GERD, which is a risk factor for more serious conditions. Long-term reflux of acid from the stomach can damage the delicate lining of the esophagus, leading to ulceration and bleeding, narrowing of the esophagus (stricture) and other problems.

What makes GERD worse?

There are several things you can do if you suffer from frequent heartburn:

  • quit smoking
  • lose weight- excess abdominal weight puts pressure on the stomach and increases the risk of reflux
  • eat smaller and more frequent meals, rather than three large meals a day
  • avoid lying down for at least two hours after eating
  • raise the head of your bed using wooden blocks under your mattress (an extra pillow will be of no benefit)
  • avoid wearing restrictive clothing around the waist
  • avoid too much caffeine (coffee, tea and soda)
  • avoid fried, spicy and acidic foods, as well as chocolate and peppermint

Medical treatment for GERD

If you experience frequent heartburn, you may have tried over-the-counter antacids such as Tums or Rolaids. These may be briefly effective at relieving your heartburn. However, these agents often contain magnesium, aluminum or calcium. If you are taking other medications or have other chronic health problems, you should not take these remedies very often without speaking to a physician.

If your heartburn is frequent and symptoms are moderate to severe, you may need a prescription medication that you can take on a regular basis. In that case, you can make an appointment to come in and see me. We’ll discuss your symptoms, what makes them worse or better and what you have tried on your own to treat your heartburn. I can prescribe an acid-blocking medication that will relieve your symptoms and allow your irritated esophagus to heal. If I am concerned that your symptoms are very severe, or that your symptoms may be caused by something else other than heartburn, I may refer you to other doctors with different expertise, but in most cases I will be the only doctor you need to see for heartburn and GERD. While you are here, we can also discuss things you can do at home to improve your symptoms.

If you suffer from frequent heartburn, make an appointment to come in and see me. Although occasional heartburn is common, frequent heartburn can be a sign of GERD, which can lead to complications if not treated. Don’t ignore frequent heartburn- make an appointment today.

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Gastrointestinal (Stomach, etc.) Health

Posted by on May 24th, 2013

Dr. Bella Zimilevich, MDGastrointestinal health issues, such as stomach pain, frequent heartburn and constipation, are some of the most common complaints I see in practice. These problems may be self-limiting or chronic in nature. They may be relatively innocuous or a sign of a serious medical issue. If you are suffering from stomach or bowel issues that are bothersome every day for longer than a couple of weeks, I want to see you”.

– Dr. Bella Zimilevich, MD

All of us suffer from stomach or intestinal upset at one time or another, but when symptoms persist they may be a sign of a more serious condition. Persistent vomiting, changes in bowel habits, abdominal distention, fever, abdominal pain, blood in the stool, weight loss and loss of appetite all require medical evaluation to rule out potentially serious disorders.

Treatment of gastrointestinal health issues starts with a visit to a primary care physician, who will be able to treat your condition in most cases. Many people assume that they will need to see a gastroenterologist for any gastrointestinal issues, but this is not usually the case. As an internal medicine physician, I am able to manage most common gastrointestinal problems; however, in the event that you require a referral to a gastroenterologist, this can be arranged through our office. I will work hand in hand with your specialist to provide you the necessary treatment and can see you regularly between specialist appointments.

It is difficult to know when symptoms are nothing to be alarmed about or cause for concern- this is where I come in. I see and treat a wide variety of gastrointestinal symptoms, including:

  • rectal pain or bleeding
  • sores in the mouth
  • heartburn/acid reflux
  • stomach pain or pain in the abdomen
  • constipation
  • diarrhea
  • vomiting
  • unintended weight loss
  • fever
  • blood in the stool

Many people are embarrassed to discuss personal issues such as their bowel habits and delay seeking treatment, hoping that the issue will go away on its own. This can be a costly mistake that can delay diagnosis of a serious, and potentially life-threatening, condition. I go out of my way to make you feel comfortable. Please feel free to ask questions and discuss symptoms freely- as a health professional, there is nothing you can tell me that we haven’t heard before! If you are experiencing gastrointestinal symptoms, make an appointment today.

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