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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.

Hemorrhoids


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
455.0 - Hemorrhoids, Internal, without Mention of Complication
455.1 - Hemorrhoids, Internal Thrombosed
455.2 - Hemorrhoids, Internal, with Other Complication
455.3 - Hemorrhoids, External, without Mention of Complication
455.4 - Hemorrhoids, External Thrombosed
455.5 - Hemorrhoids, External, with Other Complication
455.6 - Hemorrhoids without Mention of Complication, Unspecified
455.7 - Hemorrhoids, Thrombosed, Unspecified
455.8 - Hemorrhoids with Other Complication, Unspecified
455.9 - Hemorrhoidal Skin Tags, Residual

Related Terms

  • External Hemorrhoids
  • Haemorrhoids
  • Internal Hemorrhoids
  • Lump in the Rectum
  • Piles
  • Rectal Lump

Overview

Hemorrhoids are swollen, inflamed veins or vascular cushions (arteriovenous plexuses) in and around the anus and lower portion of the rectum. Internal hemorrhoids are cushions of subepithelial connective tissue located near the beginning of the anal canal, about 1 inch inside the rectum, and are a normal part of the anorectum known to be present in the developing fetus and in healthy individuals. These cushions are made up of vascular tissue (arterioles, venules, and arteriolar-venular connections), connective tissue, and smooth muscle and are covered with a mucous membrane. When the cushions become enlarged, inflamed, thrombosed or prolapsed, they produce symptoms and are then referred to as hemorrhoids. Internal hemorrhoids are not innervated by cutaneous nerves and therefore do not produce pain and can remain asymptomatic. External hemorrhoids are tiny veins located under the skin surrounding the anal opening. They are covered with epithelial layers and receive sensory impulses from the rectal nerve, making them subject to pain. Internal and external hemorrhoids can occur at the same time or separately. Internal hemorrhoids can also become enlarged and protrude from the anus (prolapsed), becoming external hemorrhoids. Symptomatic hemorrhoids can be acute or chronic; recurrence is common.

The degree of acuity of hemorrhoids determines how they are classified. First-degree hemorrhoids bleed but do not prolapse through the anus/rectum. Second-degree hemorrhoids prolapse during bowel movements but then withdraw back up into the rectum (anal canal). Third-degree hemorrhoids remain prolapsed unless pushed gently back into the anal canal, while fourth-degree hemorrhoids cannot be pushed back into the anal canal.

Hemorrhoids are caused by increased pressure on the vascular tissue and tiny veins of the rectum and anus. The most common cause of this increased pressure is excessive straining at bowel movements, due either to constipation or to small-caliber stools occurring as a result of a low-fiber diet. Other causes of increased pressure in the veins of the rectum and anus include prolonged sitting on the toilet, pregnancy and the strain of childbirth, and obesity. Other factors that contribute to hemorrhoid development include anal infection, diarrhea, delaying the urge to empty the bowels, prolonged sitting, a family history of hemorrhoids, and liver disease.

Incidence and Prevalence: Hemorrhoids are one of the most common problems of the lower digestive tract. It is estimated that hemorrhoids affect about 4.4% of all individuals or over 10 million individuals in the US (Gurley). One-half of Americans over the age of 50 suffer from hemorrhoids although the exact prevalence is unknown due to the large number of asymptomatic hemorrhoids (“Hemorrhoids”; Thornton).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Peak age range for developing hemorrhoids is between 45 and 65. A family history of hemorrhoids can be a predictive factor. Pregnant women are at increased risk of developing hemorrhoids. Elderly individuals also have greater risk as anal support structures weaken and digestive disturbances change elimination patterns.

Source: Medical Disability Advisor



Diagnosis

History: A complete health history may be obtained, including dietary patterns and family history of hemorrhoids. Individuals who suffer from both internal and external hemorrhoids may report rectal bleeding after bowel movements and / or bright red blood in the stool; however, individuals with external hemorrhoids will also report pain during bowel movements and anal itching. Individuals with internal hemorrhoids usually do not experience pain unless the hemorrhoids protrude through the anus (prolapse).

Physical exam: A digital (finger) rectal exam is usually sufficient to diagnose both internal and external hemorrhoids. A complete physical may be done to assess nutritional and health status, including the presence of possible underlying illness.

Tests: A stool guaiac test may be performed to confirm the presence of blood in the stool. Because rectal bleeding may be indicative of diseases more serious than hemorrhoids, anoscopy, proctoscopy, sigmoidoscopy, or colonoscopy may be performed to rule out any other source of bleeding and sometimes to confirm a diagnosis of internal hemorrhoids. A complete blood count (CBC) with hemoglobin and hematocrit is usually performed, as anemia can develop from even small bleeding that persists over long periods of time. Liver enzymes may be measured to rule out liver disease.

Source: Medical Disability Advisor



Treatment

Conservative treatment often is sufficient for mild hemorrhoids, especially those that occur during pregnancy, since they tend to disappear after delivery. General treatment measures include a high-fiber diet and adequate fluid intake to avoid constipation. Stool modifiers such as softeners or bulk formers may also be given, and cultivating regular bowel habits may help prevent chronic hemorrhoids. Irritation of the skin around the anus may be relieved by ointments or suppositories. Moisturized cleansing pads may be used after bowel movements to keep the anal area clean. Topical application of corticosteroid creams may help reduce pain, itching and swelling. Warm sitz baths for up to ten minutes several times a day may also relieve symptoms. Ice can be used to relieve thrombosed hemorrhoids.

Treatment of internal hemorrhoids that do not respond to conservative measures may employ various non-operative methods, including rubber band ligation, sclerotherapy injection, infrared photocoagulation, laser ablation, and freezing. The presence of specific symptoms usually indicates the type of treatment needed.

Laser ablation is used to accurately vaporize or remove hemorrhoids by sealing off nerves and tiny blood vessels with invisible light. This usually results in less discomfort, less medication, and faster healing than conventional surgery, and a hospital stay is generally not required. Laser treatment can be used alone or in combination with other modalities.

If bleeding is a problem with internal hemorrhoids, a substance can be injected into the vein to cause internal scarring (sclerosis), thus blocking the vein (sclerotherapy). The bleeding usually stops within days after the injection; however, it may recur. Since injection has little effect on prolapse, rubber band ligation may be indicated for significant vein prolapse. Alternatives include freezing the hemorrhoid (cryotherapy) and / or heating it (thermal coagulation).

Acute clotting (thrombosis) or ulceration of internal hemorrhoids may also be treated conservatively. Bedrest is prescribed to minimize swelling and prevent further thrombosis. Analgesics and sedatives may be helpful. Warm sitz baths relieve pain and swelling, and help prevent infection. Suppositories or astringent compresses also may be used to relieve symptoms. Antibiotics are sometimes indicated. The acute pain subsides over a period of 1 to 2 weeks, with the thromboses gradually being reabsorbed over a 1 to 2 month period. After the acute attack, the hemorrhoids may be ligated or removed surgically (hemorrhoidectomy).

Surgery is usually reserved for either reducible or non-reducible hemorrhoids that have severe symptoms or complications (third- and fourth-degree hemorrhoids). Surgical treatments include stapled hemorrhoidectomy and surgical resection, which are usually indicated for individuals for whom non-operative methods did not provide relief.

If thrombosis of hemorrhoidal tissue has occurred and the individual is seen within the first 48 hours, an acutely thrombosed external hemorrhoid may be relieved by removing the obstructing clot through a small incision. After that period, the clot cannot usually be removed, and is then treated conservatively; the pain usually subsides over several days.

Source: Medical Disability Advisor



Prognosis

The prognosis for both internal and external hemorrhoids is good. For mild hemorrhoids, conservative treatment is usually effective, but recurrences can occur if a high-fiber diet with adequate fluid intake is not adopted. If surgery (hemorrhoidectomy, rubber band ligation, or sclerotherapy) becomes necessary, it is usually highly successful. After five years, there is a 15% to 20% recurrence rate of internal hemorrhoids treated with rubber band ligation (Baker).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Colon and Rectal Surgeon
  • Family Physician
  • Gastroenterologist
  • General Surgeon
  • Internal Medicine Physician

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Hemorrhoids can be the source of many uncomfortable, yet generally non-serious problems. Formation of a blood clot (thrombosis) may cause severe pain. External hemorrhoids can be extremely itchy and irritated, especially if the area is allowed to remain moist. The combination of moisture and inflammation creates an environment that may encourage bacterial infection. Both internal and external hemorrhoids can result in fresh red blood oozing. Iron deficiency anemia may result from prolonged blood loss.

Source: Medical Disability Advisor



Factors Influencing Duration

Length of disability depends on the type of hemorrhoids (internal or external), presence and degree of prolapse, presence of thrombosis or ulceration, severity of symptoms, method of treatment, and presence of complications such as infection.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The extent of disability may depend on whether the individual's job involves heavy lifting, or prolonged sitting or standing. This condition is particularly prevalent among and difficult for, long-haul truck drivers and operators of heavy equipment as it combines prolonged sitting and jouncing-type pressure on the rectum and anus. Temporary accommodations may be necessary.

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 symptoms and a clinical presentation consistent with the diagnosis of hemorrhoids?
  • Was diagnosis confirmed with a rectal exam?
  • If diagnosis was uncertain, were other diagnostic tests (anoscopy, proctoscopy, sigmoidoscopy, colonoscopy) done to diagnose internal hemorrhoids or rule out conditions with similar symptoms?

Regarding treatment:

  • Were conservative measures successful?
  • Was individual compliant with treatment recommendations?
  • Did individual experience complications such as persistent bleeding or prolapsed or thrombosed hemorrhoids?
  • Was laser ablation performed?
  • Were hemorrhoids treated with more aggressive measures such as injection sclerotherapy, band ligation, cryotherapy, or thermal coagulation?
  • Is surgical intervention (hemorrhoidectomy) indicated?

Regarding prognosis:

  • Did symptoms persist or worsen despite treatment?
  • Was individual compliant with treatment recommendations?
  • Would individual benefit from dietary counseling?
  • Have hemorrhoids recurred, even after surgical treatment?
  • Does individual have a coexisting condition that could impact ability to recover such as anorectal infections, fecal impaction, and rectal neoplasms?
  • Would individual benefit from consultation with a specialist (gastroenterologist, general surgeon)?

Source: Medical Disability Advisor



References

Cited

"Hemorrhoids." National Digestive Diseases Information Clearinghouse. Nov. 2004. National Institute of Diabetes and Digestive and Kidney Diseases. 3 Mar. 2009 <http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/index.htm>.

Baker, Howard. "Hemorrhoids." Health A to Z. 14 Aug. 2006. 3 Mar. 2009 <http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/hemorrhoids.jsp>.

Gurley, David, et al. "Hemorrhoids." eMedicine. Eds. William Gossman, et al. 20 Apr. 2006. Medscape. 3 Mar. 2009 <http://emedicine.medscape.com/article/775407-overview>.

Thornton, Scott. "Hemorrhoids." eMedicine. Eds. Brian James Daley, et al. 19 Aug. 2008. Medscape. 3 Mar. 2009 <http://emedicine.medscape.com/article/195401-overview>.

Source: Medical Disability Advisor