Dr. Amiee Tieu Assists Women To Overcome Pelvic Floor Disorders
By Space Coast Medicine & Active Living // July 25, 2014
Prolapse More Common Than Women Think
BREVARD COUNTY, FLORIDA – At one point a few months back, Rene Nyberg wondered if she would ever be able to keep her organs from coming out of her body.
“It seemed my organs wanted to leave my body, while I would have preferred them to remain inside me,” said the Rockledge resident.
Nyberg’s urogynecological odyssey began in 2008 with copious vaginal bleeding that her gynecologist was not able to abate, despite cryoablation and other procedures.
“For 90 percent of women, cryoablation cuts down the flow, but it didn’t work for me,” said Nyberg.
Nyberg’s problems were to get from bad to worse, as she progressed to a prolapsed vaginal wall, rectum and bladder.
“My whole guts were coming out,” said Nyberg, who believes her condition has genetic roots, since her mother suffered from a prolapsed bladder.
“Prolapse is much more common than most women think, but nobody seems to want to talk about it.”
Life for Nyberg was a never-ending miserable experience that seemed to have no relief in sight.
“It was uncomfortable to sit, to stand, to do anything,” she said. “It was horrible, horrible, horrible.”
It wasn’t until 2013, when Nyberg approached Health First Medical Group urogynecologist Dr. Aimee Tieu that resolution to her problems finally began.
“She was so empathetic and helpful,” said Nyberg. “She made me feel I was her only patient.”
Through a series of procedures, Tieu separated the muscles from the rectum, bladder and vaginal wall and through minimally invasive robotic surgery, inserted a sacrolcopopexy mesh to keep all the organs nicely tucked in, as Nyberg had wanted.
“I got better, better and better,” said Nyberg, who has since enjoyed a cruise and participates in an exercise routine that includes walking more than two miles a day. “I feel super good.”
DISORDERS CAN HAPPEN AT ANY AGE
Pelvic floor disorders, which include pelvic organ prolapse such as Nyberg’s, as well as urinary and fecal incontinence and overactive bladder, can happen to a woman at any age. Nyberg, for example, was in her early 40s.
“Women suffering from pelvic floor disorders can range in age from their 20s to their 90s,” said Tieu. “The average patient I see has usually been dealing with her condition for a few years.”
Tieu, with Health First UroGynecology in Viera, finds that pelvic prolapse and urinary incontinence are the two most common conditions she treats. The prevalence for both of these disorders increases with age.
“A recent study showed that at least 20 percent of women will have undergone a surgical intervention for these conditions by the time they reach their 80s,” said Tieu.
“Menopausal status and lack of vaginal estrogen has been shown to increase certain conditions such as urinary frequency and infections, but is not an independent risk factor for pelvic organ prolapse or stress incontinence.”
“A recent study showed that at least 20 percent of women will have undergone a surgical intervention for these conditions by the time they reach their 80s,” said Dr. Tieu.
Younger patients typically present themselves with stress urinary incontinence, or leakage of urine when coughing, laughing, sneezing or exercising.
“As many as 25 percent of female college athletes experience stress incontinence when participating in sports,” said Tieu.
For some of these women, the problem is so severe that they stop participating in activities such as exercising or playing with their children, to their physical and emotional detriment. They need not suffer, however, for the urogynecology experts can help.
“Treatment consists of behavioral modification, physical therapy and weight loss first,” said Tieu.
“So much of my patients’ visits involve educating them about their conditions such as overactive bladder and that our bodies do a great job of regulating hydration, and if they are bothered by urinary symptoms, six to eight glasses of water a day is plenty to be healthy.”
Pharmaceutical advances have also made treatment easier.
“We are seeing much higher success with a new type of medication for the bladder called mirabegron,” said Tieu.
“The mechanism of action is completely different than traditional medications such as Ditropan and Detrol, so there are no drying side effects such as dry eyes, mouth or constipation. Having a new medication that is efficacious and well tolerated has completely changed my practice.”
Tieu has an additional treatment arsenal for more difficult cases.
“In the last few years, we have made huge advancements in diversifying our treatment of overactive bladder with the use of Botox and neuromodulation, a procedure that amplifies the inhibitory signal from the brain to the bladder to direct the bladder not to contract until socially appropriate,” said Tieu.
“This can even be done by stimulating a peripheral nerve near the ankle over a course of 12 weekly treatments in the office. There is no risk and many patients see significant improvement. Finally, Botox injected into the bladder muscle is an FDA-approved treatment and can also result in significant improvement in urge incontinence.”
Tieu also treats fistulas, abnormal connections between organs.
“In the last few years, we have made huge advancements in diversifying our treatment of overactive bladder with the use of Botox and neuromodulation, a procedure that amplifies the inhibitory signal from the brain to the bladder to direct the bladder not to contract until socially appropriate,” said Dr. Tieu.
“Urinary fistulas result in constant drainage of urine into the vagina through an opening in the bladder, urethra or ureter,” said Tieu.
“Fistulas can also cause constant stool leakage into the vagina. Most commonly, they result from traumatic birth with tears into the rectum or episiotomies that have broken down. Most are treated surgically with a closure of the abnormal connection. In my practice, the anal fistulas I see are mostly a result of diverticulitis. In these cases, I have performed combined surgeries with my husband, a laparoscopic general surgeon, to remove the colon and repair the fistula.”
SURGICAL MESH IMPORTANT OPTION
One of the “hot” topics Tieu faces almost daily with her patients is that of surgical mesh.
“It is important we discuss the facts correctly and not just what the media has portrayed,” she said.
Surgical mesh has been and continues to be an important innovation that has increased the success and longevity of our procedures for pelvic organ prolapse and urinary incontinence. All urogynecologists still use surgical mesh in certain procedurs to augment their repairs.
The recent concern regarding surgical mesh is related to transvaginal mesh placement for prolapse only. Over the last ten years, transvaginal mesh kits have been widely used to treat prolapse.
The procedure is quick, relatively effective and has good results. However, we have determined that the risks associated with the procedure are significantly higher than originally perceived. Any patient undergoing a procedure using transvaginal mesh should be well informed of the risks and benefits of the procedure.
There are well-respected, world renowned pelvic floor surgeons that use vaginal mesh kits and have low complications. However, many physicians are not as surgically skilled. We cannot expect the same results from a novice compared to an expert.
Without regulations placed on who was performing these procedures, mesh kit complications became very common.”
The field of urogynecology continues to advance at a rapid rate and treatment options have significantly expanded from just a few years ago.
“We are constantly learning and increasing our understanding of these conditions,” said Tieu and surgical techniques are continuing to improve with a push towards less invasive treatments that can be done in an outpatient setting or in the office.”
Health First UroGynecology is located at Health First Viera Hospital’s Medical Plaza, 8725 N. Wickham Road, Suite 302, in Viera, Florida. For more information, CLICK HERE, or call toll free at 855-892-9005.