Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Constipation


Medical Codes

ICD-9-CM:
564.00 - Functional Digestive Disorders Not Elsewhere Classified; Constipation, Unspecified
564.01 - Functional Digestive Disorders Not Elsewhere Classified; Constipation, Slow Transit
564.02 - Functional Digestive Disorders Not Elsewhere Classified; Constipation, Outlet Dysfunction
564.09 - Functional Digestive Disorders Not Elsewhere Classified, Other Constipation

Related Terms

  • Atonia Constipation
  • Colon Stasis
  • Fecalith
  • Inactive Colon
  • Lazy Colon
  • Obstipation

Overview

Constipation refers to the retention or delay of fecal material in the intestinal tract such that fewer than three bowel movements occur per week.

Constipation is often a symptom of another disease state, such as inflammation of the bowel (irritable bowel syndrome, or IBS), enlarged toxic colon (Hirschsprung's disease), low thyroid function (hypothyroidism), diminished inhalation/exhalation capacity of the lungs (chronic obstructive pulmonary disease, or COPD), stroke, paralysis from spinal cord injury or cauda equina syndrome, Parkinson's disease, colon cancer, tuberculosis, infection of the colon (diverticulitis), or loss of neural innervation to the colon (neurogenic disease).

Incidence and Prevalence: Constipation is the most common digestive complaint in the US, with about 3 million people reporting frequent constipation ("Constipation").

Source: Medical Disability Advisor



Diagnosis

History: Individuals will report problems having bowel movements or complain of hard, dry stools. Sensations of fullness or pressure in the rectum and a frequent urge to defecate are also common. After prolonged constipation, there may be a sense of stomach (epigastric) fullness along with nausea, belching, stomach distention, return of stomach contents into the mouth (regurgitation), or abdominal discomfort. Long-term, untreated constipation may produce headache, dizziness (vertigo), general weakness and discomfort (malaise), loss of appetite (anorexia), or a bad taste in the mouth.

Physical exam: The exam may reveal increased anal canal muscle tone and crack-like lesions on the anus (anal fissures). The individual may also have a distended abdomen and there could be an accumulation (impaction) of hardened, dry (inspissated) feces that can be felt in the area of the lower bowel (rectum, or sigmoid/transverse colon).

Tests: Tests are not ordinarily needed to ascertain that an individual has constipation because the history and physical exam will provide adequate information. However, in some cases, tests may be performed to identify the cause of constipation. Thyroid and parathyroid function tests may be performed along with a test for urinary tract infection. The interior of the colon can be inspected by inserting a flexible optic instrument (endoscope) through the rectal opening and up into the colon (colonoscopy). The colon can also be visualized on x-ray following a barium enema. Functional tests may include measurement of transit time through the colon (colorectal transit time) using radiopaque markers (colonic scintigraphy) or recording abnormal electrical activity of the colon (electromyography). Anorectal morphology and dynamics can be studied during defecation using a barium paste that reproduces stool consistency (defecography).

Source: Medical Disability Advisor



Treatment

Constipation is one of the most common gastrointestinal complaints in the US and most individuals treat themselves without seeking medical help. Those that do see a doctor are advised to increase intake of fluids and dietary fiber, and to increase physical activity as much as possible. Consuming more raw fruits and vegetables, whole grain cereals and breads, or use of supplements will increase dietary fiber intake. In some cases, individuals may be given laxatives or gastrointestinal motility drugs. However, dependence on laxatives is a possibility and their use should be monitored closely. If there is an underlying cause for the constipation, such as low thyroid levels or colon cancer, the primary disease is treated appropriately with medication or surgery (colectomy).

Source: Medical Disability Advisor



Prognosis

Most individuals can expect a full recovery and a return to normal bowel function. However, more severe gastrointestinal symptoms may appear if problems with constipation continue. If surgery is required to remove a cancerous portion of bowel, the individual may require an artificial opening (stoma) of the colon through the abdominal wall for the purpose of fecal elimination (colostomy). A colostomy may be temporary or permanent depending upon the portion of bowel that was surgically removed.

Source: Medical Disability Advisor



Differential Diagnosis

  • Colon cancer
  • Irritable bowel syndrome (IBS)
  • Low thyroid function (hypothyroidism)
  • Multiple sclerosis
  • Progressive systemic sclerosis
  • Toxic inflamed colon (Hirschsprung's disease)

Source: Medical Disability Advisor



Specialists

  • Family Physician
  • Gastroenterologist
  • General Surgeon

Source: Medical Disability Advisor



Rehabilitation

Physical activity should be increased and may involve a supervised ambulatory program, 2 to 3 times per week, 30 to 90 minutes per session (average 45 minutes). Individuals with poor muscle tone may benefit from exercising the abdominal muscles.

Source: Medical Disability Advisor



Comorbid Conditions

  • Diabetes
  • Diseases of the large intestine, including colon tumors and diverticulitis
  • Hemorrhoids, fissures, or other anorectal lesions
  • Low thyroid function (hypothyroidism)
  • Neurogenic disorders such as Hirschsprung's and Parkinson's disease
  • Obesity
  • Urinary tract infection
  • Urinary tract stones

Source: Medical Disability Advisor



Complications

Complications resulting from constipation include hemorrhoids, anal fissures and anal sphincter spasm. Very often, chronic constipation is a symptom of an underlying disease state or condition, and complications may be associated with that condition.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability depends on the underlying condition.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Most individuals will have no work restrictions or accommodations while being treated for constipation. However, restriction to light or sedentary work for 4 to 6 weeks may be required when an individual returns to the job after recovery from surgery.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual fit the criteria for constipation?
  • What is the underlying cause of constipation?
  • Does individual have an underlying medical condition that may complicate treatment or impact recovery?

Regarding treatment:

  • If there is an underlying cause for the constipation, such as low thyroid levels or colon cancer, was the primary disease treated appropriately? Is treatment for the underlying disorder effective? Will the individual require surgery to correct the underlying disorder?
  • Is the individual compliant with modification of dietary fiber and fluid intake?
  • Does individual exercise routinely?
  • If individual is taking laxatives, stool softeners, or medication to improve gastrointestinal muscle function, has he or she become dependent on these drugs to have a bowel movement? How can individual be effectively weaned off medication?

Regarding prognosis:

  • Has constipation resolved or become less frequent?
  • Has individual been compliant with treatment regimen? If not, what can be done to enhance compliance?
  • Has underlying condition responded to treatment?
  • If constipation was due to bowel cancer, was a colostomy required? Will it be temporary or permanent?
  • Have complications occurred as a result of the underlying disease or condition that caused the constipation? Are complications responding to treatment?

Source: Medical Disability Advisor



References

Cited

"Constipation." National Digestive Diseases Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. 20 Sep. 2004 <http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/index.htm>.

Source: Medical Disability Advisor