[Vocational assessment of diarrhea, incontinence and stoma].

The assessment of capability of work consist of measuring the patient subjective willingness to perform and his efficiency which should be objectively examined by functional diagnostic tools. On the one hand, there is the consideration of the patients psycho-mental burdens and on the other hand has to be defined the extent of organic functional restrictions. The latter is difficult to assess because diseased organs of the gastrointestinal tract are not directly involved in the efficiency of work. In chronic diarrhea purely watery diarrhea causes mobility restrictions at the place of work. In case of chronic malabsortive diarrhea, psycho-mental and physical deficits of efficiency have to be taken into account. The latter however may be almost restored by adequate substitution of macro and micro nutrients. For the clinical assessment of the severity of incontinence and ist psychosocial effects structured history sheets and working up of clinical findings and specifics function tests are necessary. The so defined degree of stool incontinence determines the restrictions of vocational efficiency. Generally persons with stoma are nearly not disabled and capable of gainful employment. This also pertains to professions with specific hygienic requirements, such as a production and distribution of foods. Persons with well applied and provided stomata should avoid severe physical burdens, unsuitable postures and periodical forms of labour like piece-work.