I'm a adult who recently quit using cannabis (marijuana) and have been experiencing persistent alterations in bowel movements for a couple of months, what could be causing this?

Persistent Bowel Changes After Cannabis Cessation

Your bowel symptoms are most likely related to cannabis withdrawal and the gastrointestinal system's readjustment after chronic cannabinoid exposure, which can take several months to fully resolve.

Understanding the Mechanism

The endocannabinoid system plays a critical role in regulating gastrointestinal motility through CB1 receptors, which are densely distributed throughout the gut. 1 When you use cannabis chronically, these receptors become dysregulated, and upon cessation, your GI system must recalibrate its normal function. 1 This process involves:

• Altered gastric motility and emptying that occurs through peripheral CB1 receptor activation during cannabis use 1
• Loss of negative feedback on the hypothalamic-pituitary-adrenal axis during chronic use, which affects vagal nerve function and gut regulation 1
• Readjustment period that can extend beyond the typical withdrawal timeline for other symptoms

Expected Timeline and What's Normal

Two months of persistent bowel changes after quitting cannabis falls within the expected recovery period, though it's on the longer end of the spectrum. The gastrointestinal system can take 3-6 months to fully normalize after chronic cannabis exposure. 2

When to Seek Medical Evaluation

You should see a physician if you experience any of the following warning signs:

• Rectal bleeding 3
• Severe abdominal pain, nausea, or vomiting 3
• Symptoms persisting beyond 6 months of complete cannabis abstinence 1, 2
• Weight loss or inability to maintain nutrition 4
• Fever or signs of infection 4

Management Approach

Immediate Steps

• Ensure complete cannabis abstinence - any continued use, even occasional, will prolong GI dysfunction 2, 5
• Maintain adequate hydration - the GI system needs proper fluid balance to regulate motility 5
• Avoid opioids if you're taking them for any reason, as they worsen GI dysmotility and can complicate the clinical picture 4, 2

Symptomatic Relief

For constipation-predominant symptoms:

• Start with a stimulating laxative like senna to increase bowel motility 4
• Consider adding polyethylene glycol, lactulose, or magnesium hydroxide if constipation persists 4
• Increase fluid intake and physical activity when appropriate 4

For diarrhea or alternating patterns:

• Maintain hydration as the priority 4
• Consider a low-residue diet if symptoms are severe 4

If Symptoms Persist Beyond 3 Months

Tricyclic antidepressants, particularly amitriptyline starting at 25 mg at bedtime and titrating to 75-100 mg, are the mainstay of therapy for persistent GI dysmotility related to cannabinoid system dysfunction. 2 This addresses the underlying neuromodulation of gut function.

Critical Diagnostic Considerations

While cannabis-related GI dysfunction is the most likely explanation, your physician should rule out:

• Organic obstruction or structural problems if you have severe pain or distension 4
• Other functional GI disorders like irritable bowel syndrome that may have been masked by cannabis use 4
• Metabolic causes such as thyroid dysfunction or electrolyte abnormalities 4

Common Pitfalls to Avoid

• Don't assume symptoms will resolve immediately - GI recovery takes longer than neuropsychiatric withdrawal symptoms 1, 2
• Avoid self-medicating with cannabis thinking it will help - this only perpetuates the dysfunction 2, 5
• Don't ignore persistent symptoms beyond 6 months - this warrants formal GI evaluation 1, 2

Bottom Line

Your bowel symptoms at 2 months post-cessation are consistent with the expected recovery timeline from chronic cannabis use. Continue complete abstinence, maintain good hydration, and consider symptomatic management with appropriate laxatives or dietary modifications. If symptoms persist beyond 6 months or worsen significantly, seek medical evaluation to rule out other causes. 1, 2