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.

Irritable Bowel Syndrome


Related Terms

  • Colitis
  • Irritable Colon
  • Laxative Colitis
  • Nervous Indigestion
  • Spastic Colitis
  • Spastic Colon

Differential Diagnosis

  • Celiac disease
  • Chronic dyspepsia
  • Colon cancer
  • Depression
  • Diverticulitis (inflammation of the bowel)
  • Diverticulosis (pouches formed in sigmoid colon)
  • Inflammatory bowel disease (colitis, Crohn's disease)
  • Intestinal malabsorption
  • Intestinal parasites
  • Lactose intolerance (sensitivity to milk and milk products)
  • Medication-induced constipation
  • Rectal prolapse
  • Thyroid dysfunction (hypo- or hyperthyroidism)

Specialists

  • Family Physician
  • Gastroenterologist
  • Internal Medicine Physician
  • Psychiatrist

Comorbid Conditions

  • Chronic degenerative disease (e.g., arthritis or coronary artery disease)
  • Chronic stress, anxiety, or depression
  • Fibromyalgia
  • Functional dyspepsia affecting upper gastrointestinal tract
  • Helicobacter-pylori infection of the stomach
  • Psychiatric disorders

Factors Influencing Duration

Factors that may influence any disability include the severity of symptoms and the individual's response to suggested dietary and lifestyle modifications. Psychological stress, anxiety, depression, ingestion of certain foods, and use of laxatives may also have a deleterious effect.

Medical Codes

ICD-9-CM:
564.1 - Functional Digestive Disorders Not Elsewhere Classified; Irritable Bowel Syndrome, Irritable Colon, Spastic Colon

Overview

Irritable bowel syndrome (IBS) is a functional disorder characterized by poorly localized, occasionally intense, cramp-like abdominal pain, as well as changes in bowel function. Movement (motility) of the intestine may be either increased or decreased, resulting in either loose stools (diarrhea), constipation, or both. Increased gas formation may result in bloating or distention of the abdomen. Although usually a chronic disorder, symptoms may disappear for long periods of time only to recur without warning.
No commercially available biological markers or associations with organic disease have been identified for IBS. IBS is considered a functional disorder (functional bowel) because either the muscles or the nerves of the intestinal tract are not working properly. Spasm of the pyloric sphincter between the stomach and the small intestine is a condition that sometimes occurs in conjunction with typical IBS symptoms. Pylorospasm, which can occur without any other IBS symptoms being present, occurs when the pyloric sphincter contracts spasmodically, preventing partially digested food from the stomach from entering the small intestine (duodenum) where it will be digested further. The backup of partially digested material can result in regurgitation of the stomach contents back into the esophagus, vomiting, and abdominal pain. This condition is often mistaken for IBS. Chronic dyspepsia, a functional condition of the upper gastrointestinal area, also has symptoms similar to IBS. An analysis of hundreds of studies of IBS cases has determined that it is a stable, symptom-based diagnosis.
Although the precise dysfunction of IBS is not understood, it is often thought to be related to psycho-social symptoms such as anxiety or depression. While other diseases of the digestive tract can be detected microscopically or through specific tests, it is typical in IBS for symptoms to be present while laboratory tests show negative results and imaging studies (such as CT scan, MRI, or x-ray with barium enema) reveal no abnormalities.
Symptoms similar to IBS can also occur in diverticulitis (inflamed bowel), pouches on the colon, inflammatory bowel disease (ulcerative colitis or regional enteritis), celiac disease (gluten induced autoimmune disease), lactose intolerance, and colon cancer. Unlike IBS, these conditions do have abnormal laboratory and imaging tests. IBS is also associated with fibromyalgia.

Incidence and Prevalence: IBS is a common gastrointestinal condition, affecting from 10% to 20% of adults in the US (Lucak). More women are diagnosed than men, though this is believed to be related to differences in healthcare-seeking behavior. More prevalent in lower socioeconomic groups, IBS is equally common among blacks and whites in the US.

Source: Medical Disability Advisor



Causation and Known Risk Factors

IBS is often associated with a history of mental, sexual, or physical abuse, psychiatric conditions such as anxiety or depression, and inability to handle stress. The ingestion of certain types of foods such as coffee or milk (lactose), a diet low in fiber (low-residue), or the overuse of medications such as laxatives, are believed to either cause or aggravate IBS symptoms in some individuals.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report constipation and/or diarrhea, as well as abdominal pain that may be relieved by a bowel movement. The number of bowel movements and the consistency of stools may often be different from what is normally experienced. Pain is often reported in more than one site in the abdomen or in different sites at different times. Individuals may also experience abdominal distention, bloating, and other nonintestinal symptoms such as headache, backache, fatigue, or urinary symptoms.

Physical exam: The exam may reveal an anxious or depressed, but otherwise healthy individual. The individual is not underweight. Although some distention and tenderness may be found, abdominal organs are not enlarged. The diagnosis of IBS is symptom-based, requiring at least 3 months of continuous or recurring abdominal pain that is relieved with defecation, or associated with a change in the frequency of bowel movements or consistency of the stool (Rome III).

Tests: No specific tests give a definitive diagnosis for IBS. Consequently, a fairly standard workup of diagnostic tests and procedures is performed primarily to rule out other disease states. These tests may also help reassure the individual that a more serious condition does not exist. A reasonable evaluation includes a complete blood count (CBC) and stool examination to rule out disease-causing (pathogenic) bacteria, parasites, parasite eggs, or intestinal bleeding (occult blood). A blood chemistry panel including thyroid (TSH) and amylase tests helps rule out thyroid dysfunction and pancreatic problems. A urinalysis is usually sufficient to rule out urinary tract problems. A history of chronic diarrhea suggests the need for additional testing for gluten sensitivity (Celiac disease) and lactose intolerance.
Examination of the sigmoid colon (sigmoidoscopy) using a flexible optic instrument (endoscope) may reveal abnormal spasms and mucus within the large intestine. Other diagnostic tests, more typically performed on individuals over age 50, include a full colonoscopic exam to visualize the entire colon, a radiographic procedure to visualize the colon (barium enema or "virtual colonoscopy"), or sampling a small piece of the colon for microscopic analysis (colonic biopsy). These diagnostic procedures may only be performed when IBS symptoms are accompanied by unexplained weight loss; a family history of inflammatory bowel disease, colon cancer, or celiac disease; or the presence of anemia, bowel obstruction, enlarged liver, or thyroid disorder. Anorectal motility studies may be indicated for individuals over 50 who present with IBS symptoms.

Source: Medical Disability Advisor



Treatment

Once organic disease is ruled out, treatment consists of educating the individual and providing reassurance. Supportive encouragement may help moderate the intensity of the condition. The individual is instructed on the relationship between stress, anxiousness, and/or nervousness and IBS. Behavioral modification and relaxation techniques are often beneficial. Psychiatric consultation may be warranted for diagnosing or treating depression, chronic anxiety, or obsessive-compulsive disorders. Antidepressant drugs may be effective in some individuals with IBS. A number of medications are available to treat specific symptoms.

The importance of having a regular schedule, nourishing meals, adequate sleep, and recreational activities should be emphasized. The individual is encouraged to establish a regular bowel routine. Regular exercise to relieve stress and anxiety may help moderate IBS symptoms. Any aerobic exercise such as walking, jogging, or swimming may be beneficial. It is important that the individual enjoys the exercise program so it will be done on a regular basis.

Certain foods may precipitate IBS symptoms. In general, foods to be avoided include those that are gas-producing or irritating, nondigestible carbohydrates, milk and milk-products, caffeinated beverages, and alcohol. Increased fiber in the diet may help control IBS-associated diarrhea or constipation by producing bulkier stools and reducing tension in the walls of the colon. Sources of dietary fiber include bran, whole grains such as brown rice and whole wheat, and raw and dried fruits and green leafy vegetables. Individuals should be encouraged to drink 6 to 8 glasses of water a day to regulate stool consistency and frequency. Consultation with a registered dietician may be helpful for diet education and planning. When IBS is related to chronic laxative abuse, bowel training may be necessary to correct the condition and alleviate symptoms.

Source: Medical Disability Advisor



Prognosis

Individuals with IBS may experience intermittent or chronic symptoms throughout their lifetime; 2% to 18% will experience worse symptoms, while 30% to 50% will have no noticeable change in symptoms, and still others will have symptoms subside almost completely (El-Serag). Symptoms that are more of an annoyance than a disability may be moderated with education, stress reduction, exercise, and dietary modifications. Only a small number of individuals with IBS (0.7% to 6.5%) are typically diagnosed with organic disease later in life (Lucak).

Source: Medical Disability Advisor



Complications

Hard stools, inflammation, and irritation from frequent loose stools may cause crack-like tears in the anus (anal fissures). Constipation may produce a sense of fullness along with nausea, belching, stomach distention, or abdominal discomfort. Although rare, severe diarrhea can cause dehydration and subsequent chemical imbalances. Diarrhea may interfere with daily activities or prevent individuals from venturing far from toilet facilities, causing social isolation.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions are not required, although ready access to toilet facilities may be necessary if diarrhea occurs. Symptoms are rarely severe enough to warrant time off from work other than for doctor visit.

Risk: In a normal work environment, there would be no expected job risk. For more information, refer to “Work Ability” pages 356-357.

Capacity: Individual capability should not be affected by the condition. Possible bathroom access issues may need to be explored.

Tolerance: Accommodating concerns would help alleviate barriers in returning to work. For more information, refer to “Work Ability,” pages 357-358.

Source: Medical Disability Advisor



Maximum Medical Improvement

1 week

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 testing ruled out organic disease, so that the IBS diagnosis is correct?
  • Has the diagnosis been confirmed by a gastroenterologist?
  • Has the individual accessed the EAP or psychological counseling?

Regarding treatment:

  • Has the individual received education about IBS and control of the condition?
  • If necessary, has the individual sought psychiatric consultation?
  • Has the individual met with a dietician? Has the individual followed the recommended diet?
  • Has the individual addressed correctable causes of symptoms?
  • Is the individual being treated with any medications?

Regarding prognosis:

  • Does individual exercise regularly?
  • Is individual's employer able to accommodate bathroom access for multiple episodes of diarrhea?
  • Does individual have any co-morbid conditions that may affect the ability to recover?

Source: Medical Disability Advisor



References

Cited

Rome Foundation, Inc. Rome III: The Function Gastrointestinal Disorders. 3rd ed. Degnon Associates, Inc, 2006. Rome Foundation. 6 Feb. 2013 <http://www.romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf>.

El-Serag, H. B., P. Pilgrim, and P. Schoenfeld. "Systematic Review: Natural History of Irritable Bowel Syndrome." Alimentary Pharmacology & Therapeutics 19 8 (2004): 861-870.

Lucak, S. "Diagnosing Irritable Bowel Syndrome: What's Too Much, What's Enough?" Medscape General Medicine 6 1 (2004): 17.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor






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