Impact of gum chewing on recovery of bowel activity after caesarean section

Manisha ., Nirmala Duhan


Background: Childbirth is a memorable part in every woman’s life. Each labour experience is unique and calls for a celebration. Objective of this study was to evaluate the effect of gum chewing on recovery of bowel motility after caesarean section.

Methods: This prospective randomized controlled trial was conducted on 220 women who had undergone cesarean section and were further sub-divided into two groups of 110 women each Group I (Study group, n=110) in whom chewing gum was advised postoperatively and Group II (Control group, n=110)  who were managed as per standard departmental postoperative feeding protocol.

Results: Mean age in Group A women was 24.86±3.89 years and 25.28±3.34 years in Group B. There was no statistically significant difference between the study and control group regarding their age, parity, occupation, LSCS/previous abdominal surgery, type of cesarean section, indications of cesarean section, skin incision, intraperitoneal adhesions. The mean time of bowel sound appearance in Group A was 3.27±0.95 and it was 8.22±2.0 hours in Group B. The mean time of passage of flatus was found to be 9.77±3.21 hours in Group A and 7.15±3.07 hours in Group B. In Group A, the mean time of passage of stools was 18.79±4.23 hours and it was 39.12±6.56 hours in Group B. Mean duration of hospital stay was significantly lesser (3.23±0.60 days) in gum chewing group than in the non-gum chewing group (4.18±1.28 days).  Seventy-six (69.09%) women of Group A needed only one chewing gum before appearance of bowel sound / flatus / feces. Only three women required three chewing gums. Out of 31 cases, who required two chewing gums, five were of previous 1 LSCS and 12 were previous 2 LSCS, thus suggesting delayed return of gut motility in women with > 1 previous LSCS.

Conclusions: It was evident that gum chewing, a form of sham feeding is considered as an effective and inexpensive method which hastens the return of gut motility after caesarean section.


Bowel activity, Caesarean section, Gum chewing

Full Text:



Matros E, Rocha F, Zinner M, Wang J, Ashley S, Breen E, et al. Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo-controlled trial. J Am Coll Surg. 2006;202:773-8.

Pereira S, Portela F, Santos M, Machado J, Abelha A. Predicting type of delivery by identification of obstetric risk factors through data mining. Procedia Computer Science. 2015;64:601-9.

World health organization. WHO statement on caesarean section rates. Executive Summary, WHO 2015. Available at: Accessed on 26 December 2019.

Deshpande H, Madkar C, Kale N, Sable U, Bobe A. The study of effect of sugar free chewing gum on peristalsis activity in post-caesarean patients. Indian J Res. 2017;6:4-7.

Fraser D, Copper M. Myles text book for midwives. 14th ed. London: Churchill Livingstone; 2004:455-481.

AboBaker RM. Effect of chewing gum on bowel motility in women undergoing post-operative caesarean section. Int J Innov Res Med Sci. 2018;3:25-8.

Craciunas L, Sajid S, Ahmed A. Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematic review and meta-analysis of randomized controlled trials. Br J Obstet Gynecol. 2014;121:793-9.

Hirayama I, Suzuki M, Ide M, Asao T, Kuwano H. Gum-chewing stimulates bowel motility after surgery for colorectal cancer. Hepato Gastroenterol. 2006;53:206-8.

Mansour S, Elnegeri M, Ibrahim A. Chewing gum after caesarean section: it's effect on regaining intestinal function. IOSR J Nurs Hlth Sci. 2016;5:75-8.

Safdari DF, Salehian T, Parvin N, Akbari N. Comparison of the effects of gum chewing with those of early initiation of oral feeding and routine regimen on recovery of bowel function in primiparous women after caesarean section. Sci J Kurdistan Univ Med Sci 2011;16:9-15.

Ledari FM, Barat S, Delavar MA. Chewing gum has stimulatory effects on bowel function in patients undergoing caesarean section: a randomized controlled trial. Bosnian J Basic Med Sci. 2012;12:265-8.

Rashad W, Alyousef S. Effect of sugarless gum chewing on intestinal movement after caesarean section. Life Sci J. 2013;10:3257-61.

Saxena A, Mahendru V. Factors affecting bowel motility following abdominal surgery: a clinical study. Saudi Surg J. 2015;3:1-6.

Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24 hours of colorectal surgery versus later commencement of feeding for postoperative complications. The Cochrane Database Syst Rev. 2006;18(4):CD004080.

Watt DG, McSorley ST, Horgan PG, DC MM. Enhanced recovery after surgery: which components, if any, impact on the systematic inflammatory response following colorectal surgery: a systematic review. Med. 2015;94(36):e1286.

Ho YM, Smith SR, Pockney P, Lim P, Attria J. A meta-analysis on the effect of sham feeding following colectomy: should gum chewing be included in enhanced recovery after surgery protocols. Dis Colon Rect. 2014;57:115-26.

Shang H, Yang Y, Tong X, Zhang L, Fang A, Hang L. Gum chewing slightly enhances early recovery from postoperative ileus after caesarean section: results of a prospective, randomized, controlled Trial. Am J Perinatol. 2010;2:387-91.

Jakkaew B, Charoenkwan K. Effects of gum chewing on recovery of bowel function following caesarean section: a randomized controlled trial. Arch Gynecol Obstet. 2013;288:255-60.