Abstract
BackgroundGum chewing after cesarean section may stimulate bowel motility and decrease duration of postoperative ileus.ObjectivesThe current study assessed the effect of chewing sugar-free gum on the return of bowel function, where cesarean section had been performed in nulliparous women.Materials and MethodsIn a randomized clinical trial, 60 patients, scheduled for cesarean section were randomly divided in to 2 groups gum-chewing group (n = 30) and control group (n = 30) postoperatively. The patients in the gum-chewing group postoperatively chewed sugar free gum 3 times daily each time for 1 hour until discharge. The patients' demographic characteristics, duration of surgery, mean hunger time, flatus and bowel motility were compared in the two groups.ResultsThere was no significant difference between the 2 groups regarding patient demographics, intraoperative, and postoperative care. In the gum-chewing and the control group there was a significant difference in the mean postoperative interval of the first bowel movement (20.89 ± 8.8 versus 27.93 ± 9.3 hours, P = 0.004), the first feeling of hunger (10.37 ± 6.0 versus 16.33 ± 9.3 hours, P = 0.005), the first passage of flatus (25.02 ± 5.8 versus 31.08 ± 9.7 hours, P = 0.003), and the first defecation (31.17 ± 5.3versus 40.08 ± 8.8 hours, P = 0.000) respectively, which were significantly shorter in the gum-chewing group compared to those of the control group. There were no major complications in either group. All patients in the gum-chewing group tolerated it without any major complications and side effects.ConclusionsThe study results demonstrated that bowel motility after cesarean section in nulliparous women can be accelerated by gum chewing which is a useful, inexpensive and well-tolerated method for mothers in post-cesarean section.
Highlights
Gum chewing after cesarean section may stimulate bowel motility and decrease duration of postoperative ileus
The study findings demonstrated no significant difference in terms of the mean age, duration of surgery, BMI, time to start oral feeding, serum intake, number of pregnancies, miscarriages, curettages and types of cesarean section between the control and sugarless gum chewing group of patients; the latter were well tolerating the gum and showed no feeling of dissatisfaction, and none were excluded from the study; likewise, in Shang, Ghafouri, Yaghmaei and Safdari studies, the two groups of gum-chewing and control had no significant difference on demographic variables and other mentioned characteristics [2, 5, 6, 17]; the results of the present research showed a time reduction to the first bowel movement, defecation, passage of flatus, and feeling of hunger following gum chewing after the cesarean section
The mean time to the first bowel movement revealed remarkable difference between the two groups, which is in accordance with Safdari study on the effects of gum chewing after elective cesarean section on 120 primiparous women in Shahrekord in 2011, reporting 7.4 ± 1.71 h and 15.7 ± 3.44 has the mean time to the first bowel movement in the gum chewing and the control group respectively [6]; the finding is consistent with Schuster’s study on the impact of gum chewing after sigmoid-colectomy surgery on 34 patients in 2006, in which the mean time to the first bowel movement was 63.2 ± 5.4 h and 89.4 ± 2.4 h in the gum chewing and the control group respectively [11]
Summary
Gum chewing after cesarean section may stimulate bowel motility and decrease duration of postoperative ileus. In the gum-chewing and the control group there was a significant difference in the mean postoperative interval of the first bowel movement (20.89 ± 8.8 versus 27.93 ± 9.3 hours, P = 0.004), the first feeling of hunger (10.37 ± 6.0 versus 16.33 ± 9.3 hours, P = 0.005), the first passage of flatus (25.02 ± 5.8 versus 31.08 ± 9.7 hours, P = 0.003), and the first defecation (31.17 ± 5.3versus 40.08 ± 8.8 hours, P = 0.000) respectively, which were significantly shorter in the gum-chewing group compared to those of the control group. Conclusions: The study results demonstrated that bowel motility after cesarean section in nulliparous women can be accelerated by gum chewing which is a useful, inexpensive and well-tolerated method for mothers in post-cesarean section. There is no specific treatment for postoperative ileus; several methods such as nasogastric suctioning, early feeding, intravenous fluid injection [7, 8], local analgesia, reducing intravenous drug consumption, minimal surgical manipulation, use of cyclooxygenase inhibitors, nonsteroidal anti-inflammatory drugs, and drinks with high carbohydrate content [9] are recommended to decline the occurrence of postoperative ileus
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