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.

Incision and Drainage of Ischiorectal and/or Perirectal Abscess


Related Terms

  • Anal Abscess
  • Anorectal Abscess
  • Perianal Abscess

Specialists

  • Colon and Rectal Surgeon
  • Gastroenterologist
  • General Surgeon

Comorbid Conditions

  • Diabetes mellitus
  • Gynecologic conditions, especially infection
  • Immunocompromised state (e.g., HIV, cancer, chemotherapy)
  • Infectious diseases
  • Intestinal inflammatory disease

Factors Influencing Duration

Duration is influenced by the extent of the infection, the individual’s response to surgical treatment, and the presence of any complications, including fistula formation. Sometimes individuals with diabetes develop a rapidly spreading infection of the perirectal and perineal areas called Fournier's disease, a serious condition that must be treated with hospitalization and antibiotics; surgery may be required.

Medical Codes

ICD-9-CM:
48.81 - Incision of Perirectal Tissue; Incision of Rectovaginal Septum
49.01 - Incision of Perianal Abscess

Overview

This surgical procedure is performed to drain a collection of pus (abscess) that has developed in the deeper fatty tissue on either side of the rectum (ischiorectally) or superficially around the rectum (perirectally). The abscess appears as a well-defined mass under the skin (subcutaneous) near the anus. Besides local pain, it can produce systemic symptoms of infection such as fever and chills. This is an acute condition, and surgical incision and drainage is indicated.

These abscesses result from obstruction of the anal crypts leading to an infection of the anal glands. Anal crypts normally drain the anal glands that lubricate the anal canal. Obstruction of the crypts results in accumulation of suppurative material because the glands cannot drain properly. Infection follows, and abscesses form within the glands. Less commonly, abscesses can occur from perianal skin infections, abrasions, trauma, or foreign bodies. The differential diagnosis must also include tuberculosis, adenocarcinoma, squamous cell carcinoma, actinomycosis, Crohn's disease, leukemia and lymphoma, all conditions that may result in the formation of anal fistulas.

About 60% of anal abscesses are perianal and 20% are ischiorectal (Hebra). Other types of anal abscesses also may require drainage, including intersphincteric (5%), supralevator (4%), and submucosal (1%) (Hebra). The same surgical procedure applies to draining all anal abscesses, with differences only in anatomical approach.

Source: Medical Disability Advisor



Reason for Procedure

An abscess in the rectal area is a collection of pus formed as the result of an infection. Unless it is cut open and drained, the abscess may continue to enlarge or form tube-like passages due to tissue damage (fistulae). Draining an abscess removes the infected pus, relieves the painful pressure, and allows the tissue to heal.

Source: Medical Disability Advisor



How Procedure is Performed

The depth of the abscess determines whether the procedure can be done under local or general anesthesia. The method of drainage depends on the depth of the abscess. Drainage of superficial abscesses that are large and close to the skin may be done as an outpatient procedure performed either in an office setting or often in the emergency room. After a local anesthetic is injected into the skin over the abscess, one or more incisions are made to open the abscess and allow the pus to drain. The cavity is irrigated and packed. The individual is then sent home with pain medication. Antibiotics usually are not necessary but may be given if the individual has a fever, diabetes, or other condition in which systemic infection may be more likely.

For deeper abscesses, the individual is taken to the operating room where the abscess is drained under general anesthesia. Once again, the cavity is irrigated and packed. The individual can go home after the procedure, usually the same or the next day.

Certain types of abscesses require variations in the surgical technique, especially the type of incision used. For ischiorectal abscesses, for example, the incision is made at the point where swelling is most noticeable (cruciate incision). Transverse incisions may be used for supralevator and ischiosphincteric abscesses. Placement of drains after the surgery is indicated primarily for complex or bilateral abscesses.

No further treatment is usually necessary as draining the pus cures the condition.

Source: Medical Disability Advisor



Prognosis

Most individuals are cured after the drainage procedure; however, recurrence is common after development of a first anorectal abscess. About two-thirds will develop an anal fistula, which is a tunnel from inside the anal canal to the outside skin (Hebra). This fistula can be surgically incised and drained (fistulectomy).

Source: Medical Disability Advisor



Complications

Complications from the procedure are few. Bleeding may occur or the infection may spread to other areas within the anal canal. It is rare for the anal sphincter to be damaged, which can lead to fecal incontinence. Anorectal fistula develops in about two-thirds of individuals treated with incision and drainage (Hebra). Formation of fistulous tracts can be predicted by the organism responsible for the original infection. If an enteric intestinal bacterium is the cause, fistula is likely to develop, but causative organisms such as Streptococcus or Staphylococcus usually do not result in fistula formation (Hebra).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual may need to avoid prolonged sitting. Special pillows can provide some relief when the individual must sit. Strenuous activity may need to be temporarily modified following surgery.

Source: Medical Disability Advisor



References

Cited

Hebra, Andre. "Perianal Abscess." eMedicine. Eds. Marc D. Basson, et al. 23 Feb. 2009. Medscape. 12 Sep. 2009 <http://emedicine.medscape.com/article/191975-overview>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.