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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.

Rectal Ulcer


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 | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
569.41 - Ulcer of Anus and Rectal

Related Terms

  • Solitary Rectal Ulcer Syndrome
  • SRUS
  • Ulcer of Anus

Overview

A rectal ulcer is an area of the rectal wall that is red (erythema) or has an open sore (ulceration). The condition is sometimes referred to as solitary rectal ulcer syndrome (SRUS), although the lesions are not necessarily solitary. Multiple isolated areas on the wall of the rectum may be affected. The rectal ulcer may cause bleeding and pain during the passage of stool. Rectal ulcers are rare, and there is a general lack of awareness of this condition.

A primary cause of rectal ulcers is rectal prolapse, a condition in which the lower end of the rectum protrudes through the anal orifice. Other causes may include constipation and straining during bowel movements, deficient blood flow (ischemia) to the rectum, direct trauma as a result of inserting a finger (rectal digitation) or other foreign object into the rectum, and anal intercourse.

Certain systemic diseases (oral ulceration, erythema nodosum, sacroiliitis) may also increase the risk of developing rectal ulcers.

Incidence and Prevalence: The incidence of rectal ulcer is estimated at 1 to 3 individuals per 100,000 per year (Felt-Bersma 7). Approximately 26% of individuals with a rectal ulcer are misdiagnosed. The condition affects men and women equally, and it can develop at any age. The majority of individuals with rectal ulcers are 50 years old or younger, with 25% of individuals over age 60 (Felt-Bersma 7).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals with certain psychological disorders, such as obsessive-compulsive disorder, are at higher risk of developing rectal ulcers if they practice abnormal toileting behaviors.

Source: Medical Disability Advisor



Diagnosis

History: Individuals with rectal ulcers will usually report rectal bleeding, which is the hallmark of this condition. Passing mucus, abdominal cramps, painful (but involuntary) straining while passing only small amounts of fecal material (tenesmus), constipation, diarrhea, and painful spasms of the anus (proctalgia fugax) may also be reported. The individual may also report a sense of anal obstruction. Pain is often localized to the region around the anus (perineum) or the lower back (sacral area) and is usually described as dull, continuous, and unrelieved or unchanged by defecation. About one-quarter of all individuals with rectal ulcer report no symptoms.

Physical exam: A gloved finger inserted into the anus (digital rectal exam) may reveal tenderness and bleeding. Also, a localized area of tissue firmness or hardness (induration) may be felt during the rectal exam.

Tests: The diagnosis of rectal ulcers can usually be made by examining the inner wall of the rectum using a flexible, fiberoptic viewing instrument (sigmoidoscopy). Open sores (ulcerations) will be seen on the rectal wall approximately 57% of the time; bulging, nonulcerated tissue (polypoids) are responsible for the problem 25% of the time, and inflammation (hyperemic mucosa) may be present in localized area(s) 18% of the time (Felt-Bersma 8). A tissue sample (biopsy) of the lesion for microscopic examination will be taken during a sigmoidoscopy to rule out cancerous conditions.

High-frequency sound waves (transrectal and endoanal ultrasonography) may also be used to visualize the rectum. Barium thickened to the consistency of a stool may be introduced into the rectum. Evacuation of the barium will then be monitored via fluoroscopy and videotaped (video defecography) to assess any abnormal muscle control in the lower bowel. Physiological studies (anal canal electro-sensory threshold, rectal distention threshold, resting anal manometry, anal squeeze pressure manometry) may also be performed.

Source: Medical Disability Advisor



Treatment

Treatment will be either conservative or surgical. Conservative treatment may include local application of a drug (human fibrin sealant) to stimulate cell (fibroblast) and vessel (vascular) growth; taking stool softeners; assessing any relevant psychological factors; and encouraging the individual to stop using laxatives, suppositories, and enemas.

Surgical treatments may include stitching (suturing) the ulcerated areas closed or removing (local excision) the area with rectal ulcers. If rectal prolapse has occurred, the portion of the rectal mucosa that has prolapsed may be removed (prolapsectomy) or repaired (encirclement, abdominal, or perineal procedures).

Alternatively, the entire section of the rectum containing the ulcer may be removed (resection). For some individuals who are surgically treated, a temporary or permanent opening (stoma) may need to be surgically created to permit defecation (colostomy).

Source: Medical Disability Advisor



Prognosis

There is no specific cure for rectal ulcers. Symptoms may be improved by either conservative treatment or surgery. Success rates for conservative treatment using increased fiber in the diet vary widely from 20% to 70% (Feldman 2298), but it is uncommon for tissues to completely return to normal. A combination of taking stool softeners, increasing fiber intake, and discontinuing straining while defecating produced improvement in about two-thirds of individuals. In about half of those who showed improvement, the ulcer was completely healed (Feldman 2298). At times, patients may require psychological counseling with behavior modification to assist with changing bowel habits.

Surgical excision or suturing closed the ulcerated region, in combination with correcting rectal prolapse, produced symptomatic cure in about 50% to 60% of cases (Feldman 2298). However, even after surgery, rectal ulcers may recur.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Colon and Rectal Surgeon
  • Gastroenterologist
  • General Surgeon

Source: Medical Disability Advisor



Comorbid Conditions

  • Obsessive-compulsive disorder
  • Persistent coughing (causing rectal straining)

Source: Medical Disability Advisor



Complications

Complications of rectal ulcer may include excessive rectal bleeding (hemorrhage), extreme disturbance of bowel function, formation of an abscess, formation of a hole (perforation) through the rectal wall beneath the ulcer, and surgical infection.

Source: Medical Disability Advisor



Factors Influencing Duration

The severity of symptoms and the individual's response to treatment will influence the length of disability. Mental health may also be a factor, because rectal ulcer may be more common in individuals with psychological problems. Older individuals who are treated surgically may require a longer time of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

No workplace restrictions should be necessary for individuals who are treated conservatively for rectal ulcers. If surgery has been performed, heavy physical labor may have to be restricted until recovery is complete. Workplace accommodations should also include easy access to restroom facilities if the individual has had a colostomy.

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:

  • Was a diagnosis of rectal ulcer confirmed? If the diagnosis was uncertain, was it confirmed through sigmoidoscopy, transrectal or endoanal ultrasonography, or barium enema?
  • Were physiological studies (anal canal electro-sensory threshold, rectal distention threshold, resting anal manometry, anal squeeze pressure manometry) performed to evaluate anal function?
  • Has individual experienced any complications (such as hemorrhage, disturbed bowel function, or rectal wall perforation) related to the rectal ulcer?

Regarding treatment:

  • Has individual complied with prescribed treatment plan?
  • Has individual increased dietary fiber intake? Would the individual benefit from a nutrition consult?
  • Have psychological factors been resolved? Is psychological counseling warranted?
  • Has individual stopped the use of laxatives, suppositories, and enemas?
  • If conservative treatment wasn't effective, is surgical intervention necessary?
  • If colostomy was required, is it permanent or temporary?

Regarding prognosis:

  • Has the rectal ulcer persisted despite conservative treatment?
  • Has the ulcer recurred?
  • Is individual now a candidate for surgical intervention?
  • If surgical intervention has not resolved symptoms, what further treatment is now being considered?
  • Does individual have a comorbid condition that may complicate treatment or impact recovery?
  • Does individual practice sexual behavior that involves inserting foreign objects into the anus?

Source: Medical Disability Advisor



References

Cited

Feldman, M., ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 7th ed. Philadelphia: W.B. Saunders, 2002.

Felt-Bersma, Richelle J. F., and Miguel A. Cuesta. "Disorders of the Anorectum: Rectal Prolapse, Rectal Intussusception, Rectocele, and Solitary Rectal Ulcer Syndrome." Gastroenterology Clinics of North America 30 1 (2001): 1-295.

Source: Medical Disability Advisor