Gum chewing versus traditional feeding on the early return of bowel motility after cesarean delivery: A prospective randomized controlled trial

Objectives: To compare the effects of postoperative gum chewing with traditional feeding on the early return of bowel motility after cesarean delivery. Materials: 53 women who underwent an emergency or elective cesarean section under regional anesthesia were enrolled in this trial study. Methods: Eighteen (n = 18) women were randomized to gum chewing and thirty-five (n = 35) to traditional feeding group. Gum chewing involved chewing 2 pellets of sugarless gum at 12 hours post operation for 15 minutes then advanced to sips of clear liquids at 16 hours post operation; soft boiled egg, tea and crackers after 24 hours post operation; soft diet once with passage of flatus and regular diet once with bowel movement. Traditional feeding was “nothing per orem” or “nothing by mouth” for 16 hours post operation then advanced to sips of clear liquids; soft boiled egg, tea and crackers after 24 hours post operation; soft diet once with passage of flatus and regular diet once with bowel movement. Main outcome measure was postoperative time interval to first passage of flatus, first bowel movement and length of postoperative hospital stay. Results: Compared with those in the traditional feeding group, women in the gum chewing group had a significantly more rapid onset of first passage of flatus, 20.83+6.60 hours versus 26.5+10.7 hours (p = 0.022), more rapid onset of first bowel movement, 39.28+9.96 hours versus 47.8+12.0 hours (p = 0.009), and a shorter duration of postoperative hospital stay, 47.72+8.9 hours versus 57.9+13.5 hours (p = 0.002). There were no recorded postoperative ileus symptoms or complications in either group. Conclusions: Postoperative gum chewing stimulates the earlier return of bowel motility after cesarean delivery compared to traditional feeding. It is safe, well tolerated and can be implemented without an increase in postoperative ileus.