Adding milk of magnesia to standard post-surgical recovery protocols cut the rate of postoperative ileus (bowel paralysis) from 27.5% to 3.8% and reduced time to solid food tolerance by roughly 8 hours in women undergoing hysterectomy .
Postoperative ileus (POI), a temporary loss of bowel function after abdominal surgery, remains a common and costly complication. It delays hospital discharge, increases medical costs, and diminishes quality of life during recovery. This randomized controlled trial tested whether a simple addition to an enhanced recovery after surgery (ERAS) protocol, milk of magnesia (MOM), could mitigate this problem in women undergoing hysterectomy.
The study enrolled 160 patients at Siriraj Hospital in Bangkok across 6 months. Half received standard ERAS care alone; the other half received the same protocol plus milk of magnesia dosed as 15 mL on postoperative day zero, then 30 mL twice daily until first bowel movement or flatus. ERAS pathways themselves represent a major shift from older post-operative practice: they emphasize early mobilization, optimized pain control without opioid excess, early oral intake, and avoidance of prolonged fasting. This study asked whether adding a simple osmotic laxative could further improve outcomes.
The results were substantial. Patients receiving milk of magnesia tolerated a solid diet 8 hours faster on average (20.6 hours vs 28.8 hours; p<0.001). The incidence of postoperative ileus dropped sharply: only 3.8% of the MOM group developed ileus compared to 27.5% of controls. Time to first flatus also favored the MOM group by about 5 hours (17.1 vs 22.3 hours; p<0.001). Patient satisfaction with eating and daily activity was higher in the treatment group. Critically, no serious adverse events occurred in either group, and MOM-related side effects were not reported as a safety concern.
The trial included a substantial subset with gynecologic malignancies (37.5% of patients), primarily endometrial cancer, suggesting the benefit may extend beyond benign hysterectomy cases. The consistency of results across both primary and secondary endpoints suggests the effect is not marginal.
If you're facing an abdominal hysterectomy, this study supports asking your surgical team whether milk of magnesia is part of your post-operative protocol. The intervention is inexpensive, has a long safety record, requires no prescription, and appears to speed one of the most uncomfortable aspects of post-operative recovery: the return of normal bowel function.
The mechanism is straightforward: osmotic laxatives like milk of magnesia draw water into the bowel lumen, stimulating motility without the systemic effects of prokinetic medications or the opioid-related constipation that can worsen ileus. When paired with ERAS protocols that already prioritize early mobilization and nutrition, the combination appears synergistic.
This does not mean milk of magnesia is a magic fix. Postoperative recovery depends on many factors: anesthesia choice, pain management strategy, early mobilization, and adequate hydration. This study adds one evidence-supported tool to that toolkit. Individual circumstances vary, and hospital protocols differ; discuss this specific intervention with your surgical team beforehand.
| Aspect | Details |
|---|---|
| Study type | Randomized controlled trial |
| Sample size | 160 patients (80 per group) |
| Location | Gynecology Unit, Siriraj Hospital, Bangkok, Thailand |
| Enrollment | September 2023 to February 2024 |
| Intervention | Milk of magnesia: 15 mL post-op day 0, then 30 mL twice daily until first bowel movement or flatus |
| Control | Enhanced recovery after surgery protocol alone |
| Primary outcome | Time to well-tolerated solid diet |
| Key secondary outcomes | POI incidence, time to first flatus, patient-reported satisfaction |
| Primary result | 20.6 h vs 28.8 h (p<0.001) |
| POI incidence | 3.8% vs 27.5% (p<0.001) |
| Adverse events | None reported in MOM group |
| Evidence tier | A tier |
| Registry | Thai Clinical Trials Registry (TCTR20230816005) |
Suvasu S, et al. Milk of magnesia in enhanced recovery after surgery for preventing postoperative ileus after hysterectomy: randomized controlled trial. *Support Care Cancer*. 2024. PubMed ID: 42470487
ProtocolEngine provides general health information based on published research. This is not medical advice. Consult a healthcare professional before starting any supplement or health protocol.