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.

Hernia Repair, Vaginal


Related Terms

  • Cystocele Repair
  • Rectocele Repair
  • Transvaginal Enterocele Repair

Specialists

  • Gynecologist

Comorbid Conditions

  • Obesity
  • Uterine prolapse

Factors Influencing Duration

Factors influencing length of disability include the severity of the cystocele, rectocele, or enterocele, presence of coexisting uterine conditions, surgical complications, and the job requirements of the individual. Individuals are advised to avoid heavy lifting for 3 months or more. Jobs that require heavy lifting or standing for long periods may require temporary reassignment to lighter duties.

Medical Codes

ICD-9-CM:
70.50 - Operations on Vagina and Cul-de-sac, Repair of Cystocele and Rectocele
70.51 - Operations on Vagina and Cul-de-sac, Repair of Cystocele; Anterior Colporrhaphy (with Urethrocele Repair)
70.52 - Operations on Vagina and Cul-de-sac, Repair of Rectocele; Posterior Colporrhaphy (with Urethrocele Repair)
70.71 - Operations on Vagina and Cul-de-sac, Suture of Laceration of Vagina
70.8 - Operations on Vagina and Cul-de-sac, Obliteration of Vaginal Vault; LeFort Operation
70.92 - Operations on Vagina and Cul-de-sac, Other; Obliteration of Cul-de-sac; Repair of Vaginal Enterocele

Overview

© Reed Group
A vaginal hernia repair is a surgical procedure used to correct a protrusion (herniation) of the urinary bladder into the anterior vaginal wall (cystocele), herniation of the last 6 inches of the large intestine (rectum) into the posterior vaginal wall (rectocele), or herniation of loops of small intestine or lining of the abdominal cavity (peritoneum) into the vaginal wall (enterocele).

A hernia is described as the protrusion of an anatomic structure into a defect in the tissue of another organ. Protrusions into the vaginal canal are called vaginal prolapse. Cystoceles, rectoceles, and enteroceles are types of prolapse since they are the result of a body structure that has herniated into weakened vaginal tissue. A mild (1st degree) herniation of a pelvic organ may protrude only into the upper vaginal canal, but a more severe herniation may protrude further into the vaginal canal (2nd degree) and may sometimes bulge through the vaginal opening (3rd degree).

Cystoceles, rectoceles, and enteroceles occur when the muscles surrounding the vaginal area (pelvic floor muscles) become weak. This muscle weakness may be the result of a birth (congenital) defect, reduced estrogen due to aging, multiple vaginal deliveries, removal of the uterus (hysterectomy), injury, the straining and stretching of physical activity or conditions such as obesity that cause chronic increased intra-abdominal pressure.

Cystocele develops from weakening of the pubocervical vesical fascia. The protrusion of the bladder may include just a small part of the bladder wall or all of the bladder and the tube leading from the bladder to the outside of the body (urethra). Rectocele is a relaxation of the rectal support structures (levator ani muscles) and subsequent herniation into the vaginal canal. It can occur in women who have never been pregnant or given birth. An enterocele develops after previous surgery (usually hysterectomy) has weakened the vaginal wall; the enterocele sac bulges out from the top of the vaginal canal (apex) when the individual is upright and loops of small intestine become trapped inside. In about 72% of cases, prolapse of the vaginal apex that occur after hysterectomy is a combination of cystocele, rectocele, and enterocele (Katz).

Source: Medical Disability Advisor



Reason for Procedure

Vaginal hernia repair usually is performed when nonsurgical (conservative) treatment has failed to relieve discomfort, improve bladder control, correct constipation or fecal incontinence, or prevent painful intercourse (dyspareunia).

Cystocele repair is indicated if there is an inability to control the flow of urine (urinary incontinence), obstruction of the urinary tract or urethra because of the severity of the cystocele, difficulty emptying the bladder, or if the cystocele protrudes into the entrance of the vagina. Rectocele or enterocele repair is indicated if there is discomfort or protrusion of the herniation into the entrance of the vagina, urinary incontinence, difficulty emptying the bladder, incomplete defecation, or chronic constipation. The goals of surgery are to restore normal vaginal depth and angle (axis), relieve symptoms of pressure, and maintain urinary and fecal continence and sexual function. If repair of herniations is delayed, painful vaginal wall ulceration may occur. Cystocele, rectocele, and enterocele repairs may be done separately or at the same time, depending on the specific condition of the individual.

Source: Medical Disability Advisor



How Procedure is Performed

Vaginal hernia repair can be done on an inpatient or outpatient basis. The woman receives either a general or regional (epidural) anesthesia and is placed on her back with her buttocks on the edge of the surgical table and her legs elevated and positioned in a support device that includes stirrups for the feet (dorsal lithotomy position). The vagina is held open using an instrument called a speculum. The prolapsed tissue is lifted back into its proper position and attached to healthy portions of pelvic ligaments. Extra tissue is removed, and the affected area is then sewn (sutured) into place with surgical thread (sutures). After surgery, the vagina may be packed with antibiotic-soaked dressings for about a day. Oral or intravenous antibiotics may be administered. The individual may have a catheter for a few days if she is unable to empty her bladder after the procedure.

Source: Medical Disability Advisor



Prognosis

Repairing vaginal prolapse with fixation to healthy ligaments has almost a 100% success rate; however, recurrent herniation requiring repeat surgery may occur in up to 33% of cases (Katz). Success rates and relief of symptoms for cystocele repair vary depending on the severity of the herniated bladder. Rectocele repair and enterocele repair yield a good outcome with relief of symptoms in a majority of cases.

Source: Medical Disability Advisor



Complications

Possible complications include allergic or abnormal reactions to anesthesia, continued difficulty emptying the bladder, recurrence of symptoms of urinary incontinence or recurrence of vaginal prolapse. Persistent pain, infection, bleeding, scarring of the vaginal wall, an abnormal opening between the vaginal wall and other areas (fistula), and painful urination are other risks of surgery. Repeat surgery to repair cystoceles, rectoceles, or enteroceles may involve an abdominal approach (e.g., laparoscopy) rather than a vaginal approach, and a different type of surgical repair may be required (e.g., anterior or posterior colporrhaphy, perineorrhaphy) to prevent recurrence.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Lifting and strenuous activity or extended standing may need to be restricted for of several weeks. Driving a motor vehicle may be restricted for up to 2 weeks after surgery.

Source: Medical Disability Advisor



References

Cited

Katz, V. L., et al., eds. "Chapter 20: Anatomic Defects of the Abdominal Wall and Pelvic Floor." Comprehensive Gynecology. 5th ed. Mosby Elsevier, 2007. MD Consult. Elsevier, Inc. 23 Sep. 2009 <http://www.mdconsult.com>.

McNeeley, S. Gene. "Cystoceles, Urethroceles, Enteroceles, and Rectoceles." The Merck Manual of Diagnosis and Therapy. Eds. Robert S. Porter, et al. 18th ed. Whitehouse Station, NJ: Merck and Company, Inc., 2008. Merck Manuals Online. Merck & Co., Inc. 23 Sep. 2009 <http://www.merck.com/mmpe/sec18/ch250/ch250b.html>.

General

Walsh, Patrick C., et al., eds. Campbell’s Urology. 8th ed. 4 vols. Philadelphia: W.B. Saunders, 2002. MD Consult. Elsevier, Inc. 23 Sep. 2009 <http://home.mdconsult.com>>.

Source: Medical Disability Advisor






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