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.

Fissurectomy, Anal


Related Terms

  • Anal sphincterotomy

Specialists

  • Colon and Rectal Surgeon
  • General Surgeon

Comorbid Conditions

  • Gastrointestinal disorders

Factors Influencing Duration

The severity of the underlying condition, extent of treatment required, presence of complications, and individual response to treatment can affect length of disability.

Medical Codes

ICD-9-CM:
49.0 - Incision or Excision of Perianal Tissue
49.02 - Incision of Perianal Tissue, Other; Undercutting of Perianal Tissue
49.04 - Other Excision of Perianal Tissue
49.22 - Perianal Tissue Biopsy
49.3 - Local Excision or Destruction of Other Lesion or Tissue of Anus; Anal Cryptotomy; Cauterization of Lesion of Anus
49.31 - Endoscopic Excision or Destruction of Lesion or Tissue of Anus
49.39 - Other Local Excision or Destruction of Lesion or Tissue of Anus
49.51 - Left Lateral Anal Sphincterotomy
49.52 - Posterior Anal Sphincterotomy
49.59 - Other Anal Sphincterotomy; Division of Sphincter NOS
49.6 - Excision of Anus
49.7 - Repair of Anus

Overview

An anal sphincterotomy is the surgical incision or division of the sphincter muscle that controls the anal opening (anus). Generally, it is the first surgical choice for treatment of painful cracks or tears (fissures) that develop in the interior passageway of the distal anal canal where fecal matter is channeled for final elimination from the body. Fissures usually involve just the outer skin of the anus (epithelium) but also can involve the full thickness (anal mucosa). The procedure involves cutting through the outer areas of the opening to the rectum (anal sphincter) to stretch and relax tight internal muscles; this helps prevent excessive contractions (spasms). Surgery is reserved for the acute fissures that persist after unsuccessful medical treatment or for chronic or frequently recurring fissures.

Conservative treatment methods are tried first. When these treatments do not correct the problem, usually as a last resort, an anal sphincterotomy may be performed at the same time as a fissurectomy to remove (excise) painful fissures.

Anal fissures may occur when muscles of the anal sphincter begin to spasm as a stool passes, resulting in trauma to the anal canal. No work-related activity or specific occupation is associated with fissure development. Fissures most often develop in individuals who consume a low-fiber diet and have hard stools that are difficult to pass or who have persistent constipation. Fissures also may be linked to diseases including inflammation of the lining of the rectum (proctitis), inflammatory bowel disease (Crohn's disease or ulcerative colitis), leukemia, or certain types of cancer. In rare cases, syphilis or tuberculosis also may be an underlying cause of fissures.

Source: Medical Disability Advisor



Reason for Procedure

Healing may be very difficult to achieve when anal fissures develop in the sphincter area and progress upward into the anal canal. Other, more conservative methods of treatment are tried before a sphincterotomy or fissurectomy is recommended, and can include the use of fiber supplements; stool-bulking laxatives or stool softeners to relieve constipation that often leads to fissure development; direct application of ointments (nitroglycerine); and botulinum toxin (Botox) injections as a "chemical sphincterotomy." When these methods fail, an anal sphincterotomy, or a fissurectomy (the excision of painful fissures), or both, may be considered to ease muscle contractions and possibly relieve pain, with the ultimate goal of healing the fissures.

Source: Medical Disability Advisor



How Procedure is Performed

Anal sphincterotomy is performed under general or spinal anesthesia either on an outpatient basis or in an office or clinic. Any skin tags associated with the fissures first may be cut away. Sphincterotomy can be performed as either an open or closed procedure. In a closed procedure, incisions are made into the outer area of the sphincter to relax muscles and the internal sphincter is also pulled up to be incised and relaxed. The surgeon avoids cutting into the anal mucosa, which could cause fistula development postoperatively. In an open procedure, an incision is made along the internal sphincter plane and the internal sphincter is looped and brought up into the incision and cut under the surgeon's direct visualization. After being cut, the separate ends fall back into the canal and a relaxed internal sphincter can be palpated. Once the procedure is completed, the wounds are left open or, in rare cases, closed with sutures. In some cases in which anal fissures need to be removed, a fissurectomy is performed and any wounds are closed with sutures or sealed with electrically generated heat (electrocoagulation or electrocautery) to prevent bleeding. The individual will be asked to practice extremely good hygiene, keeping the area washed especially after bowel movements. Individuals also may be placed on stool softeners and/or high fiber diets to ease passage of stools while healing takes place.

Source: Medical Disability Advisor



Prognosis

Pain stops almost immediately after surgery and patients can resume normal activities after the first 24 hours. While outcomes with sphincterotomy generally are good, about 12% to 27% of individuals who have had stretching of the external anal sphincter may develop inability to control stool passage (fecal incontinence); lower rates are reported for internal sphincterotomy (Poritz). Degrees of continence difficulty vary from minor soiling and flatulence to uncontrolled stool passage. These symptoms may appear only during a short period following surgery without continuing long term. Fissures recur in about 1% to 6% of patients postoperatively. Up to 50% of individuals with Crohn’s disease may not heal well (Poritz).

Source: Medical Disability Advisor



Complications

Complications from surgery may include infection, difficulty breathing, or rapid heartbeat (tachycardia) as a reaction to anesthesia, and/or excess bleeding (hemorrhage). Anal fistulae may develop in some individuals. In rare cases, the individual may have permanent problems with anal sphincter function that may result in fecal incontinence and/or inability to control passage of gas.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

After recovery, no work restrictions or special accommodations are required. No work-related activity is associated with development of fissures.

Source: Medical Disability Advisor



References

Cited

Poritz, Lisa S. "Anal Fissure." eMedicine. Eds. David L. Morris, et al. 16 Jul. 2009. Medscape. 14 Sep. 2009 <http://emedicine.medscape.com/article/196297-overview>.

Source: Medical Disability Advisor






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