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, Interstitial


Related Terms

  • IC
  • LC
  • Painful Bladder Syndrome
  • Submucous Cystitis

Differential Diagnosis

Specialists

  • Gynecologist
  • Infectious Disease Internist
  • Internal Medicine Physician
  • Urologist

Comorbid Conditions

  • Autoimmune diseases (e.g., rheumatoid arthritis, lupus)

Factors Influencing Duration

Length of disability is influenced by the severity of symptoms, the type of treatment, and its effectiveness.

Medical Codes

ICD-9-CM:
595.1 - Cystitis, Chronic Interstitial; Hunners Ulcer; Panmural Fibrosis of Bladder; Submucous Cystitis

Overview

Interstitial cystitis, also known as painful bladder syndrome, is a chronic (more than 6 weeks) noninfectious inflammation of the urinary bladder of unknown cause, probably multifactorial. Pinpoint areas of bleeding (glomerulations) develop in the bladder wall, resulting in scar tissue that causes the bladder to stiffen and contract, making it less able to expand, and markedly reducing its capacity. Interstitial cystitis is much less common than cystitis caused from a bacterial urinary tract infection (UTI).

Incidence and Prevalence: Interstitial cystitis occurs in approximately 60 to 70 out of 100,000 women in the US (Rovner).

Source: Medical Disability Advisor



Causation and Known Risk Factors

About 2.6% of women in the United States have symptoms of interstitial cystitis. Women account for 90% of cases, and the overwhelming majority of these women (94%) are white, with an average at diagnosis of 40 years (Rovner). Some researchers believe that interstitial cystitis in men is underdiagnosed because symptoms can overlap with those of chronic proctitis.

The exact cause of interstitial cystitis is unknown. Possible causes include disorders in which the body's immune system mistakenly attacks the bladder (autoimmune disorder), an allergic reaction, hormonal disturbances, defects in the mucous lining that normally protect the bladder, the presence of toxic substances in the urine, or an abnormality of the spine (lumbar nerve root compression). Interstitial cystitis might also be related to scarring from a condition in which fragments of the uterine lining are found in other parts of the pelvic cavity (endometriosis) or from surgical removal of the uterus (hysterectomy), since women who experience interstitial cystitis more commonly have both these conditions.

Biological risk factors include previous UTIs, gynecological surgery, and immunological disease. Some research is investigating possible genetic factors of interstitial cystitis.

Source: Medical Disability Advisor



Diagnosis

History: Symptoms range from mild discomfort, pressure, and lower abdominal (suprapelvic) tenderness to intense bladder pain felt in the suprapubic area, cramping with urination, frequent urination (frequency), feeling pressure (urgency) to urinate, abnormally excessive urination during the night (nocturia), and burning or pain with urination (dysuria). Pain increases as the bladder fills, causing an uncontrollable urge to urinate; urination produces relief of pain. In most cases, a course of antibiotics will fail to resolve the symptoms. Individuals may also have chronic pain in the pelvis or between the genital area and anus (perineum). In severe cases, individuals may urinate more than 60 times a day, and up to 10 times during the night. Individuals may also report pain during sexual intercourse (dyspareunia). Symptoms may increase during menses, as well as with sexual activity, exercise, and stress. Coffee, tea, carbonated drinks, tobacco, alcohol, and spicy or acidic foods may aggravate the symptoms.

Physical exam: In women, a pelvic exam is done to rule out other conditions that could cause similar symptoms, such as vaginal infection or endometriosis. In men, the urethral opening is examined for evidence of a skin lesion, swelling, or discharge. The prostate and testes are examined for swelling and tenderness and to rule out conditions such as urethritis, prostatitis, and orchitis.

Tests: Urinalysis and urine culture are performed to rule out UTI. In men, prostatic fluid is also analyzed. Interstitial cystitis is suspected if the urine culture is sterile while symptoms continue over a period of weeks or months. Fiber-optic examination of the bladder (cystoscopy) under anesthesia reveals pinpoint bleeding caused by chronic irritation as well as thickening and inflammation of the bladder wall; benign bladder (Hunner) ulcers are identified in 5-10% of individuals with the condition. During the course of the cystoscopy, a tissue sample may be removed for biopsy; microscopic examination can confirm the presence of inflammation and rule out bladder cancer.

Source: Medical Disability Advisor



Treatment

There is currently no cure for interstitial cystitis. Treatment is aimed at symptomatic relief. Dietary changes focus on avoiding irritating substances such as spicy and potassium-rich foods, citrus fruits, tomatoes, coffee, tea, chocolate, alcohol, and tobacco.

Pentosan polysulfate, a medication intended to increase the protective layer of the bladder wall, may be prescribed. Oral pain relievers such as aspirin, ibuprofen, or codeine may be helpful. Tricyclic antidepressants such as amitriptyline or imipramine, generally administered in lower doses than when administered for depression, have beneficial incidental effects that reduce the chronic pain and the stress that accompany interstitial cystitis. Another option involves delivering dimethyl sulfoxide or other medicated solutions directly into the bladder through a urethral catheter. Aimed at inhibiting painful inflammation, this technique involves treatments every other week for at least 6 to 8 weeks. Some highly motivated individuals may be trained to catheterize themselves so that they can perform the treatments at home.

A procedure called transcutaneous electrical nerve stimulation (TENS), which delivers mild electric pulses to the bladder area, may help relieve pain and urinary frequency in some cases. Sacral nerve root stimulation, a surgical variation of TENS, involves permanent implantation of electrodes and a unit emitting continuous electrical pulses.

Stretching the bladder by filling it with fluid under pressure (hydrodistention) can bring temporary relief from symptoms.

Rarely surgery may be considered as a last resort if more conservative treatments are ineffective and symptoms are severe. Surgery includes burning off (fulguration) or cutting away (resection) ulcers using instruments inserted into the urethra through a cystoscope, surgical augmentation of the bladder using tissue from the individual's large intestine, or bladder removal (cystectomy). After a cystectomy, urine is usually collected in a bag (appliance) attached to a stomal opening in the abdomen. Continent urinary diversions eliminating the need for an appliance can be offered to the individual.

Support groups specifically for interstitial cystitis may be helpful in addressing the emotional aspect of dealing with a chronic disorder.

Source: Medical Disability Advisor



Prognosis

Interstitial cystitis is a chronic disease. Individuals are helped by careful management of the condition and adjustment of treatments to provide maximum short-term relief. Studies of entire patient populations have indicated that no currently available treatments have a significant long-term impact on symptoms. In many cases, symptoms disappear either spontaneously or in response to some particular treatment, but often recur.

Source: Medical Disability Advisor



Complications

Complications include stiffening of the wall of the bladder with reduced bladder capacity, and chronic pelvic pain. Frequent urination and pain may lead to lower quality of life, sexual intimacy problems, emotional troubles, and depression.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Frequent and unscheduled breaks are usually necessary due to the constant urge to urinate. The opportunity to perform gentle stretching exercises also seems to help many individuals with interstitial cystitis.

Risk: Those affected by frequent nighttime urination may present an increased safety risk to themselves and coworkers due to fatigue. No job causes interstitialcyctitis.

Capacity: Capacity may be affected by urinary frequency requiring more frequent bathroom breaks. If surgery was performed, adequate recovery time will be necessary before returning to full work duties.

Tolerance: Individuals with interstitial cystitis may need counseling to help them cope with chronic, ongoing symptoms. Tolerance of chronic intermittent bladder pressure and discomfort varies according to the nature of the pain and the frequency of the urge to urinate. Individuals may benefit from instruction in lifestyle changes to allow a balance between activity and rest and to reduce dietary intake of food and beverages that trigger the symptoms.

Accommodations: Individuals with interstitial cystitis may need rapid, readily-available bathroom access while at work.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 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:

  • Has individual had previous urinary tract infections?
  • Does individual have an autoimmune disorder? Hormonal disturbances? Endometriosis?
  • Does individual have a toxic substance in their urine? Spine abnormality?
  • Has individual had a hysterectomy?
  • Does individual experience pain, burning, or cramping with urination?
  • Does individual have urinary frequency and urgency? Nocturia?
  • Does individual report that antibiotics have failed to resolve the problem?
  • Does individual report symptoms worsening during the menses?
  • Does individual have dyspareunia?
  • Was a pelvic exam done?
  • Were the prostate, testes, and urethral opening examined?
  • Have a urinalysis and culture been done? Prostatic fluid examined?
  • Has individual undergone cystoscopy? Was a biopsy done?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has pentosan polysulfate, been tried? Oral pain relievers? Tricyclic antidepressants?
  • Has individual received dimethyl sulfoxide directly into the bladder through a catheter?
  • Was hydrodistention tried?
  • Has individual avoided spicy and potassium-rich foods, citrus, tomatoes, coffee, tea, and chocolate in diet?
  • Does individual avoid alcohol?
  • Has individual quit smoking?
  • Did a cystectomy become necessary?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that could affect his or her ability to recover?
  • Does individual have urinary reflux or chronic pelvic pain?
  • Is individual involved in a support group or counseling?

Source: Medical Disability Advisor



References

Cited

Rovner, Eric, et al. "Interstitial Cystitis." eMedicine. 10 Apr. 2014. Medscape. 22 Apr. 2015 <http://emedicine.medscape.com/article/2055505-overview>.

Source: Medical Disability Advisor






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