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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.

Neurogenic Bladder


Text Only Home | Graphic-Rich Site | Definition | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Return to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
596.54 - Other Functional Disorders of Bladder, Neurogenic Bladder NOS

Related Terms

  • Neuropathic Bladder

Overview

Nerves carry messages from the bladder to the brain, signaling when the bladder is full. The brain responds by signaling bladder muscles to either tighten or relax. Neurogenic bladder is a disorder in which the nerves transmitting these messages malfunction. This failure interferes with bladder control and its capacity to act as a reservoir for urine.

The symptoms arising from a neurogenic bladder depend on the function of the involved nerves that are damaged. Malfunction of the nerves innervating the bladder may be caused by trauma to the brain or spinal cord. Congenital abnormalities can also result in nerve dysfunction. In some cases, failure of these nerves to work properly results in a flaccid, distended bladder that constantly leaks small amounts of urine (hypotonic neurogenic bladder). In other individuals, the nerves controlling the bladder muscles contract and empty the bladder involuntarily (spastic neurogenic bladder). Sometimes bladder muscles fail to receive the message that it is time to contract, so the bladder remains full. In such cases, the bladder becomes overly distended and urine may back up into the kidneys, causing undue pressure with damage to the tissues of the kidney. Stagnant urine remaining in the bladder for prolonged periods is susceptible to infection.

Diseases that are risk factors for neurogenic bladder include diabetes, multiple sclerosis, amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease), Parkinson's disease, herpes zoster, and syphilis. Strokes, brain and spinal cord tumors, ruptured intervertebral discs, acute infections, surgical errors, and heavy metal poisoning can also cause nerve damage resulting in a neurogenic bladder.

Incidence and Prevalence: Overall, the inability to control urination (incontinence) affects 8.5% of women and 1.6% of men between 15 to 64 years old (Lansang). The incidence of neurogenic bladder varies depending on primary cause. In the US, the incidence in individuals with multiple sclerosis is 40% to 90%, Parkinson's disease 37% to 72%, and stroke 15% (Lansang).

Source: Medical Disability Advisor



Diagnosis

History: The individual with a hypotonic bladder usually complains of wet underclothes due to urinary leakage, while those individuals with a spastic bladder may be unable to void completely, or inadvertently void after a strong, sudden urge (urge incontinence).

Physical exam: A neurogenic bladder that fails to completely empty will result in bladder distention that is easily felt (palpated). Signs of reduced anal sphincter control may also be evident. The neurological exam may be abnormal depending on the underlying cause of neurogenic bladder.

Tests: A urinalysis is usually done to rule out bladder infection. Tests may be ordered to assess bladder capacity and function. These include x rays of the bladder, urethra, and upper urinary tract following the introduction of a radiopaque substance (cystography, urethrography, or pyelography), ultrasound imaging, examination of the bladder and urethra using a fiber-optic instrument (cystourethroscopy), measurement of bladder size and reaction to pressure (cystometrography), measurement of urine flow rates (urodynamic assessment), and tests of muscular reaction to electrical stimulation (electromyography). To diagnose underlying problems in the brain or spinal cord, x rays of the skull and spine, as well as an electroencephalogram (EEG) may be performed.

Source: Medical Disability Advisor



Treatment

Treatment of neurogenic bladder will depend on the underlying cause of nerve damage and resultant type of voiding dysfunction. Involuntary bladder contractions and lack of sphincter muscle coordination are treated with drugs to improve bladder control, to prevent muscle spasms (antispasmodics), and to block certain nerve impulses (anticholinergics and alpha-sympathetic blockers). Some clinicians have tried electrical stimulation of the bladder, sacral nerves, or spinal cord with promising results. Appropriate management includes monitoring for urinary tract infection and kidney disease, and encouraging the individual to drink sufficient fluids, limit calcium intake, and change position frequently. Individuals are encouraged to walk, if possible.

Individuals with urge incontinence modify their diet to avoid spicy foods, citrus fruits, chocolate, and caffeine. Pelvic floor muscles can be strengthened with Kegel exercises, physical therapy, and biofeedback.

Individuals with a spastic bladder may facilitate bladder emptying by timed voiding techniques to empty the bladder frequently before bladder contraction occurs. When the bladder is hypotonic, manual compression via the Valsalva or Credé maneuver can help empty the bladder. Some individuals with a hypotonic bladder as well a spastic bladder will require the insertion of a flexible tube through the urethra into the bladder to drain it of urine (catheterization). This can be done intermittently throughout the day by the affected person (self-catheterization). In other cases, continuous catheterization is necessary.

If the condition cannot be managed satisfactorily by conservative therapy, surgery may be necessary. If the sphincter muscle is the main problem, an artificial sphincter can be implanted. Urine flow may also be diverted. The bladder can be opened through the abdominal wall (cutaneous vesicostomy) with urine flowing into an external appliance, or the ureters can be divided and urine diverted into an intestinal conduit.

Source: Medical Disability Advisor



Prognosis

Complete recovery from a neurogenic bladder is uncommon, so the goal of treatment is to manage its effects. Appropriate therapy and careful management can often produce satisfactory results. In individuals with mild involvement, therapy complemented by incontinence pads will provide enough relief for the individual to sustain a relatively normal lifestyle. Often, however, catheterization is required. If the individual is physically able and motivated to learn intermittent self-catheterization, this procedure will yield a better quality of life, fewer complications, and less disability than continuous catheterization.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Nephrologist
  • Neurologist
  • Urologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Immune system disorders

Source: Medical Disability Advisor



Complications

Potential complications of neurogenic bladder include kidney damage due to urine backup (reflux and hydronephrosis) from an overextended bladder. Eventually, kidney insufficiency may result in a toxic condition in which waste products remain in the blood (uremia) rather than being excreted in the urine. Urine retention may also lead to infections of the bladder, ureters, and kidneys (cystitis, pyelonephritis), and stone (calculi) formation in the urinary tract.

Source: Medical Disability Advisor



Factors Influencing Duration

Duration depends on the underlying condition, individual response to treatment, and presence of complications.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual may require time off for frequent doctor visits necessary for both regular monitoring and to avoid the possibility of infection or other complications. On the job, the individual may need longer than usual breaks and a suitable restroom facility in order to deal with such hygiene tasks as changing incontinence pads, emptying and cleaning an external appliance, or performing self-catheterization. Individuals with such an appliance or who wear a catheter may need to be reassigned if their ordinary work is physically strenuous. Those who perform intermittent catheterization may require a flexible work schedule.

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:

  • Is individual's nerve malfunction congenital or related to brain or spinal cord malfunction?
  • Is condition secondary to other diseases such as diabetes, multiple sclerosis, amyotrophic lateral sclerosis, or syphilis?
  • Has individual had a stroke?
  • Does individual have a brain or spinal cord tumor?
  • Does individual have a ruptured intervertebral disc?
  • Does individual have an acute infection?
  • Was there a surgical procedure where an error may have occurred?
  • Has individual been exposed to heavy metals?
  • Does individual leak urine constantly, or does individual inadvertently urinate after a strong, sudden urge?
  • Is a distended bladder felt with palpation?
  • Does individual have reduced anal sphincter control?
  • Have appropriate diagnostic tests been performed to characterize the specific cause of neurogenic bladder, so that appropriate treatment can be provided?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual been treated with the appropriate drugs to improve bladder control, prevent muscle spasms, and block certain nerve impulses?
  • Is individual complying with instructions, including alterations in diet and fluid intake?
  • Is individual being monitored for infection and kidney involvement?
  • Would individual benefit from therapy to help strengthen pelvic floor muscles for incontinence control?
  • Has individual been trained in self-catheterization?
  • Did individual have surgery?

Regarding prognosis:

  • Does individual have senile dementia or immune suppression?
  • Is individual's employer able to make accommodations for the individual's situation?
  • Has individual had any complications?

Source: Medical Disability Advisor



References

Cited

Lansang, Ramon S., and Andrew C. Krouskop. "Bladder Management." eMedicine. Eds. Teresa L. Massagli, et al. 9 Dec. 2004. Medscape. 3 Jan. 2005 <http://emedicine.com/pmr/topic231.htm>.

Source: Medical Disability Advisor