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.

Cystitis, Acute


Related Terms

  • Acute Cystitis
  • Bladder Infection
  • Cystitis
  • Urinary Tract Infection
  • UTI

Differential Diagnosis

Specialists

  • Family Physician
  • Gynecologist
  • Internal Medicine Physician
  • Urologist

Comorbid Conditions

  • Immune system disorders
  • Urinary tract structural defects

Factors Influencing Duration

The administration of appropriate antibiotic treatment will influence the length of disability.

Medical Codes

ICD-9-CM:
595.0 - Cystitis, Acute

Overview

Acute cystitis is a symptomatic inflammation of the lining of the urinary bladder (the mucosa) caused by a bacterial infection. It is a type of urinary tract infection (UTI), and accounts for most of the cases.

Most infections occur when bacteria that originate in either the small or large intestine (coliform bacteria) travel up the urethra into the bladder. Once bacteria enter the bladder, they normally are eliminated during urination. Symptoms occur when bacteria multiply faster than they are eliminated.

Incidence and Prevalence: This condition is rare for males but very common for females; adult women have 30 times greater risk than men of developing a UTI. About 25% to 40% of women in the US aged 20-40 years have had a UTI. Cystitis occurs in 0.3-1.3% of pregnant women (Brusch). In men, cystitis occurs most often after age 50.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Acute cystitis occurs mainly in adult women, as bacteria that inhabit the vaginal opening and anus are easily introduced into the area surrounding the urethral meatus (entrance) during intercourse or while performing normal hygiene.

Risk factors include diabetes, which can result in urine with an unusually high concentration of glucose (glycosuria or glucosuria) that encourages bacterial growth; a diet low in fruit and protein, as a lack of these foods makes urine less acidic and thus more hospitable to bacteria; using an ill-fitting contraceptive diaphragm, which can prevent complete emptying of the bladder; poor hygiene habits, such as cleaning from back to front after defecation, or wearing soiled underwear. Other risk factors include urinary tract obstruction, a neurogenic bladder, depressed immune system response (e.g., HIV/AIDS), insertion of medical instruments into the urinary tract, backflow of urine from the bladder into the ureters (vesicoureteral reflux), pregnancy, bowel incontinence, immobility, or decreased mobility.

In men over age 50, cystitis occurs most often is caused by incomplete emptying of the bladder as a consequence of prostatitis, prostatic enlargement (benign prostatic hyperplasia [BPH]), and urethral strictures.

Source: Medical Disability Advisor



Diagnosis

History: Onset is generally sudden. The most common complaints include a frequent, urgent need to urinate while passing only small amounts of urine (urgency and frequency), painful and burning urination (dysuria), discomfort felt as pressure or mild to moderate pain in the lower abdomen (suprapubic) and back (flank), a sensation of bladder fullness, loss of bladder control (incontinence), strong urine odor, cloudy urine, low-grade fever, and a vague feeling of bodily discomfort (malaise). There may be blood in the urine (hematuria) usually non-visible (microscopic) or rarely gross (hemorrhagic cystitis).

Physical exam: Minimal physical findings are present in individuals with acute cystitis. Palpation (touching) of the flank or lower abdomen (suprapubic region) and costovertebral angle may elicit complaints of tenderness or pain. The individual may have constitutional complaints such as fatigue, chills, nausea, and/or vomiting. Confusion or mental changes may be present and may be the only sign of cystitis in an elderly person.

Tests: Acute cystitis is usually suspected by its distinct symptoms. Urinalysis is used to confirm the diagnosis. Precautions must be taken to avoid contaminating the urine specimen with bacteria from the external genitalia by first cleaning with a disinfectant and then obtaining a midstream specimen (clean catch). Nitrites and leukocyte esterase will be present in the urine. Microscopic examination of the urine reveals many white blood cells (pyuria), while red blood cells (hematuria) are seen about half the time. If complicated UTI or infection of the kidneys (pyelonephritis) is suspected, the urine is cultured to identify the causative bacteria, and antibiotic susceptibility testing (AST) is carried out.

Source: Medical Disability Advisor



Treatment

Acute cystitis is generally treated with antibiotics for 3 to 10 days. Commonly used drugs include nitrofurantoin, trimethoprim/sulfamethoxazole (TMP/SMX), fosfomycin, or a fluoroquinolone such as ciprofloxacin. When culture and AST are done, antibiotic therapy may be modified based on the results. A urinary tract pain reliever (analgesic) such as phenazopyridine may be given for the first 1 to 2 days to reduce burning and discomfort.

The individual is encouraged to drink two or more quarts of water per day to encourage flushing of the bladder with dilute urine. Low-dose long-term (prophylactic) antibiotics may be given in cases of recurring cystitis.

Preventive measures include good genital hygiene and other practices, such as emptying the bladder immediately following sexual intercourse, to help prevent additional infections.

Source: Medical Disability Advisor



Prognosis

Acute cystitis is usually cured rapidly with antibiotics. Indeed, the condition may resolve without antibiotic therapy, and some individuals self-treat with fluid loading. However, antibiotics provide symptomatic relief, lessen the length and severity of the disorder, and reduce the incidence of complications and recurrence.

Source: Medical Disability Advisor



Complications

Possible complications include progression of the infection to the ureters, pyelonephritis, and renal failure.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The employee may need to take more frequent restroom breaks. No other special needs are anticipated. However, in many cases the urgent need to urinate is so constant that work may be impractical for a day or two until the medication begins to take effect.

Risk: There is no risk to the individual when performing job duties with acute cystitis. Individuals with repeated cystitis infections may require counseling to make appropriate lifestyle changes (e.g., good hygiene practices, a diet rich in fruits and proteins) to reduce the risk of recurrence.

Capacity: Capacity is typically unaffected with this condition although individuals with urge incontinence may be temporarily unproductive at work. Once the infection has resolved, no impact on capacity is anticipated.

Tolerance: Tolerance varies from individual to individual, but most individuals are able to perform their normal job duties during an episode of acute cystitis. Individuals compliant with increasing their water consumption to help flush the urinary tract with dilute urine may require more frequent restroom breaks than usual.

Source: Medical Disability Advisor



Maximum Medical Improvement

3 days.

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:

  • Did individual present with common genitourinary symptoms such as urinary urgency, frequency, dysuria, incontinence, or abdominal pain?
  • In individuals with suspicion of complicated UTI or pyelonephritis, was a urine culture done?
  • Was AST done to determine the appropriate antibiotic treatment?
  • Are the bacteria cultured resistant to the antibiotic used?
  • Did individual warrant further diagnostic studies to rule out an underlying urinary tract defect (e.g., stricture or prostatic hypertrophy)?

Regarding treatment:

  • Has individual completed the full course of antibiotic therapy?
  • Was individual instructed to increase fluid intake to 2 quarts or more per day?
  • If cystitis is recurrent, would individual benefit from prophylactic antibiotics?

Regarding prognosis:

  • Did the symptoms persist? Was a repeat culture and sensitivity done to rule out the possibility of antibiotic resistance? Were appropriate adjustments in the antibiotic therapy made?
  • Were additional studies done to determine if the infection progressed to the ureters or kidneys?
  • Does individual have a history of recurrent cystitis?
  • Has individual been examined for the possibility of other urinary tract disorders?
  • Does individual have any underlying conditions such as diabetes, immune system dysfunction, or structural abnormalities that may affect recovery and prognosis? Have these conditions been addressed in the treatment plan?
  • Has individual been instructed on hygiene and other practices, such as emptying the bladder immediately following sexual intercourse, to help prevent additional infections?

Source: Medical Disability Advisor



References

Cited

Brusch, John, et al. "Cystitis in Females." eMedicine. 7 Apr. 2014. Medscape. 22 Apr. 2015 <http://emedicine.medscape.com/article/233101-overview>.

Source: Medical Disability Advisor






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