REVIEW QUESTION

Can chewing gum reduce the duration of postoperative ileus and enhance recovery after a cesarean section?

TYPE OF REVIEW

An intervention review of 17 randomized controlled trials.

RELEVANCE FOR NURSING

A transient impairment of bowel motility (ileus or paralytic ileus) is expected after cesarean section and usually resolves spontaneously within a few days. However, it can cause considerable discomfort, require symptomatic medication, and delay hospital discharge, which increases costs. Chewing gum is a simple intervention shown to be effective in enhancing recovery of bowel function immediately after abdominal surgeries. Ileus resolution is defined by the passage of flatus and/or stool.

Risk factors for ileus include longer surgery time, extensive manipulation of the abdominal cavity, and blood loss. These conditions occur more frequently in women with one or more previous cesarean sections. Use of opioids during labor and postoperative analgesia also contribute to delayed bowel function.

CHARACTERISTICS OF THE EVIDENCE

This review sought to assess the effects of gum chewing in reducing the duration of postoperative ileus and in enhancing recovery after a cesarean section. The primary outcomes were time to the first passage of flatus, the proportion of women with ileus within the first 72 hours after cesarean section, and the tolerance to and adverse effects of gum chewing within the same time frame.

This review included 17 randomized controlled trials (a total of more than 3,000 women) that assessed the effects of chewing gum in enhancing the recovery of bowel function after a cesarean section. All the trials compared chewing gum with usual care in women in the immediate postpartum period (within the first 24 hours). Usual care was a conventional feeding protocol (no food until bowel movements resumed) or an early feeding protocol (food less than six to eight hours following surgery) without gum chewing.

The intervention was chewing gum, at least once daily, in any dose or time interval; therefore, the trials could not be blinded. Studies with gum that contained an active therapeutic agent were not included unless the agent was also given to the control group.

Chewing gum after cesarean section reduced the time to first passage of flatus by seven hours and the time to first passage of stool (a secondary outcome) by about nine hours. Chewing gum also reduced the rate of ileus by over 60%. Intolerance to the intervention was very low with no adverse effects reported.

BEST PRACTICE RECOMMENDATIONS

This review shows that chewing gum in the immediate postoperative period after a cesarean section is effective in enhancing early recovery of bowel function. The evidence indicates that this intervention is well tolerated by most women and there was no evidence of potential adverse effects. This simple, effective intervention could easily be integrated into routine post-cesarean section protocols.

RESEARCH RECOMMENDATIONS

Chewing gum after a cesarean section is a simple, cheap, easy intervention that appears to be safe and well tolerated. However, the quality of the evidence across all outcomes was low mainly because of the heterogenicity of study designs, high risk of bias in most studies, and inability to blind. The authors stated that more high-quality research is needed to identify the optimal dose and timing of gum to achieve best outcomes and to assess potential risks.

REFERENCE