The side effects of nicotine withdrawal are well-known to would-be quitters: irritability and anxiety, depression, trouble sleeping — not to mention the cravings. But research shows one in six former smokers or vapers will also experience bothersome gastrointestinal symptoms, and for 1 in 11, those symptoms can be severe.
I was on day 10 of no nicotine, and my gut was flat out not happy. After almost 15 years of being an on-again, off-again smoker, I had once again decided it was time to quit smoking.
But the same thing that often led me to light back up — or in the past couple of years, to turn to vaping — was plaguing me again: intense bloating and days-on-end constipation. You know what was a certain remedy? A stiff cup of black coffee and a cigarette or puff from my vape.
No, not this time, I told myself. This time, I was going to get regular without nicotine or excessive caffeine. But how? To start, I needed to understand why my body came to depend on stimulants to keep my digestive train running in the first place, and learn how to change that.
Why Does Nicotine Make You Poop?
The gut is lined with nerves, much like the nerves in your brain. Chemicals called neurotransmitters activate the nerves by binding to receptors, a bit like a key unlocking a door. Because its chemical shape is similar, nicotine can bind to receptors for a neurotransmitter called acetylcholine, which plays a role in arousal, heart rate, attention, memory, and — you guessed it — digestion.
According to the gastroenterologist and certified addiction medicine specialist Anthony Albanese, MD, when a person smokes or vapes, nicotine binds to those receptors and increases gut motility, or the speed of food and gas moving from the stomach through the end of your digestive tract. The same thing happens when you drink your morning cup of coffee. The problem is, over time your body comes to depend on the external stimulation of nicotine to keep your bowels moving.
“As with any type of drug use, tolerance can develop,” explains Dr. Albanese, who serves as a professor and the vice chair of medicine at the University of California in Davis. “It's a little bit like a pendulum. The body tries to find normalcy somewhere, so it counterbalances the excessive stimulation and changes as a result of that.”
But when you stop smoking, your body doesn’t have the nicotine “keys” it has come to rely on to unlock the bathroom door. “All of a sudden, you are left in an unbalanced state again” — hello constipation! — “and it sometimes takes a while for the body to return,” he says.
Your Bowel Movements Change After You Quit Smoking
Even if you aren’t completely backed up, once you quit smoking or vaping you may notice your stool resembles paltry nuggets: smaller, harder, more compact. It may also be more difficult to pass stool or gas. Albanese says that’s thanks to your colon, whose primary function is to absorb water after most nutrients have been absorbed in the small intestine. As gut motility slows down, waste spends more time in the colon, which means more water is drawn away before your stool makes it to the exit.
Because we are creatures of habit, any change in our guts can be very noticeable. “If we make changes in that flow for any reason — we speed it up or we slow it down — it doesn't feel normal to us,” Albanese says. What’s interesting, he says, is that “different people perceive things in different ways.” One person may experience a change in motility as mild bloating, while another may feel like the extra pressure in their gut is the worst pain of their life.
How to Treat Post-Smoking Constipation
Addressing intestinal health when you quit smoking can be invaluable to your success, Albanese says, because gut distress can actually trigger nicotine cravings. “You may say, ‘I know how to make this go away. I'll just have a cigarette.’” Except that’s what you’re trying to give up.
So how can you help your gut get back to a consistent and comfortable routine after you quit smoking? The answer may be counterintuitive: You would think if things are building up, Albanese says, you’d want to use a laxative or some other stimulant to get them out. But that just perpetuates the problem of relying on a drug, and doesn’t allow your body to find its happy digestive place on its own. Instead, he says, “one of the ways that we address this is by adding fiber to the diet.”
Fiber Can Lubricate Your Colon After You Quit Nicotine
If waste is moving through the body at a slower pace, that means more water is being absorbed by the intestines, and making your stool harder and more difficult to pass. Increasing the amount of water in your intestines can help you get back to regular, comfortable bowel movements.
Fiber accomplishes this task by holding on to water and carrying it to our intestines.
You can simply up your fiber intake through food, but it’s important to note that the natural fiber in foods like prunes and beans can cause gas and bloating for some people. This is also true for psyllium husk, a natural fiber supplement that’s usually mixed with water or juice.
If you fall in that camp, a better bet is a nonnatural, nonfermentable fiber supplement called methylcellulose. Sold under the brand name Citrucel and mixed in water, this type of fiber will lubricate your pipes without creating excess gas, Albanese says. It could be weeks or even months, though, before you notice a change; everyone’s body is different.
Luckily, this supplement has very few side effects. If you overdo it, though, Albanese says, the most common side effects are cramps, nausea, and diarrhea. Methylcellulose can also decrease the absorption of medications, he says, “so we ask people not to take it at the same time as their prescription medications,” and instead take it two hours before or after.
OTC Drugs Can Help Constipation and Gas, but Avoid Laxatives
There are a few other over-the-counter remedies you can try if you’re dealing with bloating or constipation. Polyethylene glycol, an over-the-counter drug mixed in with water and sold under the brand name Miralax, also keeps more water in your stool to ease its passage, according to Michael Epstein, MD, a principal physician at Gastro Health in Annapolis, Maryland. OTC stool softeners are also okay to use for occasional constipation, he says.
If bloating is bothering you, it doesn’t hurt to try anti-gas medicines like simethicone or activated charcoal, but they’re not effective for everyone, Albanese says.
When it comes to other potential at-home remedies for constipation, though, it’s best to avoid stimulant laxatives or “move teas,” like those that contain bisacodyl or senna, because they can damage the lining of the colon over time, Dr. Epstein says.
Exercise, Diet Changes, and Probiotics Can Help Constipation When You Quit Smoking
Albanese says that exercise is another thing that most people find helps their bowels move and stay in good health. “Some type of daily activity that is appropriate for your age and any medical conditions, but yet is intentional,” he says.
For me, that was running 6 to 10 miles per week. Training for a 10K kept me motivated during my grumpy phase.
Drinking more fluids, like water, and cleaning up your diet, likewise, may relieve constipation. The low-FODMAP protocol in particular, Epstein says, can help people who struggle with gas and bloating. It’s a big commitment, though, and you may find that just eliminating hard-to-digest fructose (part of the protocol) makes a difference.
Because nicotine can change the makeup of your microbiome, or the particular types of bacteria that live in your gut, both doctors say some of their patients saw benefits from taking probiotic supplements after they quit smoking. But they don’t help everyone, and probiotics are no longer recommended by the American Gastroenterological Society for most digestive conditions.
Some people see benefits from eating probiotic-rich foods like yogurt and kefir. This may involve some trial and error to find types and amounts that help you.
Your Doctor Can Help With Constipation After Nicotine Cessation
If constipation and gas are preventing you from quitting smoking or vaping, it’s a good idea to go see your doctor. You may not think these issues rise to the level of an office visit, but that’s the farthest thing from the truth.
“If it's what stands between you sticking to your plan [to quit], it's definitely worth it to go see your doctor,” Albanese says. “We have tricks and things that we can do,” including prescription medications and specific diet advice.
When Can I Expect to Poop Normally After Quitting Smoking or Vaping?
Both doctors said the length of time it can take to regain bowel regularity is highly variable, from a month to nine months or more. For me, the first two weeks after the last drag from my vape were the most excruciating, both mentally and specifically for my gut. I was painfully bloated until day 11, and I didn’t have a regular-for-me bowel movement until day 17. Three months in, I’m having a respectable bowel movement every other day — and I’ll take it. I’m also breathing better, my anxiety has decreased somewhat, and I’m saving money.
But I still get cravings, especially when I feel like I need to go and it’s just not happening. That’s part of the journey, a sentiment Albanese agrees with. “It's a normal thing for our bodies to call us back to something that's worked for us. It’s the way our memory works, the way our physiology works. … That’s a normal part of recovery.”
He adds that it’s good to prepare yourself for a climb out of a valley, one that’s going to take effort for longer than you think. “Most people try to quit smoking six to eight times before they are fully successful,” he says. But, as I can attest, it’s worth it.