From the Guidelines
Cessation of cannabis use can cause constipation in some individuals.
Gastrointestinal Disturbances
The onset of constipation typically occurs within 24 to 48 hours after cessation of cannabis use, with symptoms persisting for up to 2 weeks 1.
- Symptoms: In severe cases, constipation may be accompanied by other withdrawal symptoms, such as abdominal cramps and nausea.
- Management: Management with medications like polyethylene glycol 3350 (17 grams per day) or bisacodyl (5-10 mg per day) for a duration of 7-10 days may be required.
Pathophysiology
The endocannabinoid system plays a crucial role in the development of gastrointestinal disturbances, including constipation, after cannabis cessation 1.
- CB1 Receptors: Stimulation of CB1 receptors can lead to loss of negative feedback on the hypothalamic–pituitary–adrenal axis, resulting in increased vagal nerve discharges contributing to gastrointestinal disturbances.
- Gut-Brain Interaction: CHS is a chronic disorder of gut–brain interaction characterized by nausea, vomiting, and abdominal pain related to chronic cannabis use 1.
Clinical Approach
The clinical approach to managing constipation after cannabis cessation involves immediate evaluation for life-threatening disorders and differential diagnosis in the outpatient setting 1.
- Differential Diagnosis: Differential diagnosis in the outpatient setting after exclusion of structural abnormalities includes rumination syndrome, gastroparesis, CVS, pregnancy, migraine, and functional chronic nausea and vomiting syndrome.
- Treatment: Treatment for CHS is limited to case series and small clinical trials supporting the use of topical capsaicin, benzodiazepines, haloperidol, promethazine, olanzapine, and ondansetron for acute and short-term care 1.
From the Research
Cannabis Withdrawal Symptoms
- The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite 2.
- Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain 2.
- Women reported a stronger cannabis withdrawal syndrome than men, including physical symptoms such as nausea and stomach pain 3.
Gastrointestinal Symptoms
- There is limited evidence on the specific gastrointestinal symptoms associated with cannabis withdrawal, but some studies suggest that cannabis use can be associated with gastrointestinal disorders, including gastroesophageal reflux disease, pancreatitis, and peptic ulcer disease 4.
- However, none of the studies provided directly link cannabis cessation to constipation.
Cannabis Cessation and Withdrawal
- Cannabis withdrawal symptoms tend to occur within 48 hours following cessation of regular cannabis use, and include increased irritability, anxiety, nervousness, restlessness, sleep difficulties and aggression 5.
- Symptoms subside within 2 to 12 weeks 5.
- Perceived barriers for cannabis cessation are associated with cannabis use problems, withdrawal symptoms, and self-efficacy for quitting 6.
Conclusion on Constipation
- There is no direct evidence in the provided studies to suggest that cessation of cannabis use causes constipation.