I have a history of cannabis use and have recently quit, now I'm experiencing oscillating bowel movements between diarrhea and constipation, what could be causing this and how can I manage my symptoms?

Cannabis Withdrawal Syndrome with Gastrointestinal Symptoms

Your oscillating bowel movements between diarrhea and constipation are most likely due to cannabis withdrawal syndrome, which affects approximately 47% of regular cannabis users after cessation and typically resolves within 1-2 weeks. 1

Understanding What's Happening

Your gastrointestinal symptoms represent a direct consequence of cannabis withdrawal affecting your gut motility. Cannabis activates CB1 receptors throughout your enteric nervous system, which normally modulate neurotransmitter release and control intestinal transit. 2 When you abruptly stop using cannabis after chronic use, your gastrointestinal system loses this regulatory influence, causing erratic bowel patterns as your body readjusts. 1

Timeline and Expected Course

• Symptom onset: Your symptoms likely began within 24-72 hours after stopping cannabis 1
• Peak intensity: Days 2-6 after cessation represent the worst period 1
• Resolution: The acute withdrawal phase, including your bowel irregularities, should resolve within 1-2 weeks 1
• Persistent symptoms: If vomiting or severe GI symptoms continue beyond 2 weeks, this suggests cannabinoid hyperemesis syndrome (CHS) rather than simple withdrawal 3, 4

Immediate Management Strategy

For Diarrhea Episodes

Use loperamide (standard antidiarrheal agent) as needed for loose stools. 1 This directly addresses the symptom without interfering with your withdrawal recovery.

For Constipation Episodes

Standard over-the-counter stool softeners or osmotic laxatives (like polyethylene glycol) can be used during constipated periods, though avoid stimulant laxatives which may worsen the oscillating pattern.

Critical Medications to Avoid

Do not use opioids for any abdominal discomfort, as they worsen nausea, carry high addiction risk, and do not address the underlying pathophysiology. 1, 4

When to Worry: Red Flags

You need urgent evaluation if you experience:

• Persistent vomiting (especially if it continues beyond 2 weeks or occurs in cycles) 3, 4
• Severe abdominal pain that could indicate acute abdomen, bowel obstruction, mesenteric ischemia, or pancreatitis 3, 4
• Compulsive hot water bathing to relieve symptoms, which is pathognomonic for CHS 3, 4
• Blood in stool or unintentional weight loss

Distinguishing Withdrawal from CHS

This distinction is critical because the management differs:

Cannabis Withdrawal Syndrome (what you likely have):

• GI symptoms begin after stopping cannabis 1
• Symptoms resolve within 1-2 weeks 1
• No cyclic vomiting pattern 1

Cannabinoid Hyperemesis Syndrome (less likely but important to rule out):

• Vomiting occurs during active chronic use (>1 year, >4 times weekly) 3, 4
• Stereotypical episodic vomiting (≥3 episodes annually) 3, 4
• Requires 6 months of abstinence for complete resolution 3, 4
• Hot water bathing provides temporary relief 3, 4

Additional Supportive Measures

Monitor for anxiety and depression, as these commonly emerge or intensify during cannabis withdrawal and can exacerbate GI symptoms through the gut-brain axis. 1 Consider psychological support or counseling if anxiety becomes prominent. 1

Maintain regular sleep patterns and adequate hydration, as these support your body's natural recovery from withdrawal. 5

If Symptoms Persist Beyond 2 Weeks

Seek gastroenterology evaluation if your bowel irregularities continue past the expected 1-2 week withdrawal window. 1 At that point, you would need assessment for:

• Possible CHS (requiring 6 months abstinence for definitive diagnosis) 3, 4
• Other functional gastrointestinal disorders 5
• Underlying conditions unmasked by cannabis cessation 5

The good news: if this is straightforward cannabis withdrawal syndrome, your symptoms should improve significantly within the next week and resolve completely within 2 weeks of your last cannabis use. 1