Role of Gum Chewing in Post-operative Gut Motility After Cesarean Section

Many women deliver by caesarean section nowadays. The proportion of women who deliver by caesarean section ranges from 15% to over 50%, in some countries. After a caesarean section it is common for the bowel to stop working for several hours or days. Although this usually resolves by itself in a few days, it may be very uncomfortable. The retained gases and stools can cause the mother's belly to become swollen and painful with cramps and she may feel nauseated and vomit so she is not able to eat. She may need additional medications to ease these symptoms and her hospital discharge may be delayed. The use of medications that relieve pain during labour and painkillers following the surgery can also delay bowel function. Small intestine activity after abdominal operations returns to normal function within a few hours, gastric activity returns to normal within 24-48 hours, and colon activity returns to normal within 48-72 hours. Due to the delayed motility of the gastrointestinal system in the postoperative period, gas and secretions accumulate in the stomach and small and large intestines, which causes abdominal distension, nausea, vomiting, and pain, all of which negatively affect the comfort level of the patients. Chewing sugar-free gum after cesarean section can promote the early recovery of gastrointestinal function, but the side effects of chewing gum are still unclear, which needs more clinical, large sample and high-quality studies to further verify.

Study Overview

• Status: Completed
• Conditions: Cesarean Section; Gum Chewing; Gut Motility
• Intervention / Treatment: Dietary supplement: Sugar free chew gum; Other: Nil Per Oral

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Gujranwala, Punjab, Pakistan, 52230
      • CMH Gujranwala

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Females of age 18-40 years
• Parity <5
• Presenting at gestational age ≥ 37 weeks,
• Undergoing cesarean section (as per operational definition) under spinal anesthesia

Exclusion Criteria:

• Females with history of chronic constipation (medical record)
• Females with obstructed labour, hypothyroidism (TSH>5IU)
• Females with intra operative complications such as bowel injury, history of gastrointestinal surgery, and water and electrolyte disturbances (on medical record), abnormal placenta (accrete, increta, previa, abruption)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A participants who were given chewing gum 6 hours after the surgery, three times a day; In group A participants were given chewing gum 6 hours after the surgery, three times a day till passage of flatus	Dietary supplement: Sugar free chew gum; Chew gum has a role in ERAS protocol which is significant in early post operative recovery as compared to normal routine care methods
Active Comparator: Group B participants who were kept nil per oral till bowel sounds were audible; In group B, participants were managed as per standard routine protocol i.e. allowing oral when gut sound were audible	Other: Nil Per Oral; According to classic protocols patient were kept nil per oral till bowel sounds were audible

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Time of Passage of First flatus	In group A, females were given chewing gum 6 hours after the surgery, three times a day till passage of flatus. In group B, females were managed as per standard routine protocol i.e. allowing oral when bowel sounds are audible. Mean time of passage of first flatus since procedure was noted in terms of hours.	06 Months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Duration of Hospital Stay	In both groups mean duration of hospital stay was noted in terms number of days required to stay in the hospital after cesarean. Patients were discharged once they were pain free and on oral medication.	06 Months

Collaborators and Investigators

• Sponsor: Dr Maryam Aslam
• Collaborators: CMH Gujranwala

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2024
• Primary Completion (Actual): October 31, 2024
• Study Completion (Actual): October 31, 2024

Study Registration Dates

• First Submitted: April 20, 2025
• First Submitted That Met QC Criteria: April 29, 2025
• First Posted (Actual): May 1, 2025

Study Record Updates

• Last Update Posted (Actual): May 1, 2025
• Last Update Submitted That Met QC Criteria: April 29, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: 275

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No