Chewing gum may be the answer to postoperative gas problems

Warning: this column contains information about a bodily function not usually discussed in public – passing gas.

Once upon a time, in my former life, I was an obstetrician gynecologist who, with some regularity cut women’s bellies open – to get a baby out, to remove a traitorous uterus, to save a woman bleeding internally from a ruptured tubal pregnancy. And pretty routinely, about day two after the operation, I would joke that I was going to invent a cure for postoperative gas and become a millionaire. (I never did.)

Reacting to surgery, the bowels would just puff up, making my poor patients miserable. When things started working again, my patient would agree that she had never been so happy to do something so socially unacceptable – pass gas.

For a variety of reasons, the intestine shuts down after abdominal surgery – no one knows exactly why, but stress chemicals released after the surgery, the trauma of moving the bowel around, the irritation of the abdominal incision and the effects of pain medications all have been implicated. We doctors call that ileus, and it’s usually a transitory thing.

Surgeons have long had their pet ideas and disagreements about what to do to prevent the build-up of gas.

Some say grape juice is OK, others say apple juice is better. One surgeon wouldn’t let his patients eat until they’d had a bowel movement. By then they were starving!

The gas is merely a symptom of the intestine’s failure to get moving after belly surgery. Generally, things perk up between the second and fourth day after operation, depending on the nature of the surgery.

But sometimes the intestine doesn’t get going, and patients experience pain, bloated belly and nausea. And that means a longer hospital stay.

Studies have shown that, unlike what my colleague (the one who took forever to feed his patients) thought, early feeding actually encourages the bowel to do its thing.

Giving patients water as early as four to six hours after surgery works for some, but for others it comes right back up again. Hardly pleasant when you’ve just had surgery.

Surgeons at Santa Barbara Cottage hospital, writing in the Archives of Surgery, may have found the answer: chewing gum. Armed with a study showing that after laparoscopic colon surgery chewing gum helped accelerate the return of bowel function, they decided to do a study on patients who were having part of their colons removed through an abdominal incision.

The 34 patients were undergoing surgery either because of diverticulitis or cancer. Half got chewing gum, and the other 17 served as controls.

On the first postoperative day, patients began chewing gum. They chewed one stick of sugarless gum three times a day – morning, afternoon and evening. Their nurses kept track of when they chewed, when they first passed gas, when they had their first bowel movement and when their appetite returned.

The gum-chewing group did better in all areas. They felt hungry almost 10 hours sooner than the control group, passed gas 15 hours sooner and had their first bowel movements more than a day sooner. At a cost of 4 cents a stick.

Now, this was a very small study. It couldn’t be “double blind” because there’s no placebo for chewing gum.

The participants weren’t told that the expectation was they would leave the hospital earlier, but they did – two and a half days sooner.

The researchers surmised that the chewing gum triggered what’s called the “cephalic-vagal reflex.” You chew, and it sets off nerve signals that get the juices going. They also speculate that the gum chewing caused the secretion of “pro-motility” factors that act directly on the intestine.

It’s a simple intervention, but an extremely cost-effective one.

Saving two days in the hospital is nothing to sneeze at, given the number of abdominal surgeries performed each year. So if abdominal surgery is in your future, ask your surgeon about therapeutic gum-chewing.