Ozempic constipation: causes and treatment

Ozempic (semaglutide) comes along with a possible side effect of constipation, characterized by infrequent or difficult-to-pass bowel movements.  This is because Ozempic reduces gastrointestinal motility,which means food moves slower through the body’s digestive system. The good news is that, for most people, Ozempic constipation is usually temporary and manageable. 

Ozempic may cause constipation for a few reasons. Ozempic works in part by delaying gastric emptying, the movement of stomach contents into the intestines. This effect can make a person feel full faster and longer after eating, which is part of how the medication supports weight loss. People may feel satisfied with less food than usual, compared with before starting Ozempic. But slower digestion can also mean slower movement of food throughout the entire digestive tract, which can lead to constipation. 

GLP-1 agonist medications such as Ozempic mimic the effects of a natural hormone called glucagon-like peptide-1 (GLP-1), which has been shown to reduce gastrointestinal motility, the muscle contractions that move food movement of contents through the digestive system tract. When these contractions slow down, stool can become harder and more difficult to pass. This change may also explain why Ozempic can cause constipation.

Ozempic can also  reduce your sense of thirst, which can lead to  drinking less water throughout the day without realizing it. Not getting enough fluids is one of the most common causes of constipation.

Because Ozempic reduces appetite, you may also eat smaller portions overall. And if nausea (another common side effect) leads you to reach for bland, low-fiber foods like crackers or white toast to settle your stomach, the drop in fiber intake can make constipation worse. 

Get started

Treating constipation from Ozempic (semaglutide) is important to avoid serious complications. Left untreated, complications of constipation may lead to hemorrhoids, anal fissures, trouble controlling bowel movements (fecal incontinence), and/or intestinal damage.

The following strategies can help manage constipation with Ozempic. If these strategies do not provide relief, seek medical advice from a healthcare provider to prevent constipation from escalating into a more significant health issue.

Avoid low-fiber foods 

Low-fiber foods can slow digestion and make bowel movements difficult. Adjusting eating habits to avoid certain foods on Ozempic can help support regular bowel movements. One place to start is cutting back on low-fiber foods that can cause or worsen constipation, such as:

• Fried foods

• Processed foods, such as packaged snack foods

• Sugary beverages

• Red meat

Too much dairy, coffee, or alcohol can also contribute to or worsen constipation. However, everyone's digestive system is unique, and what helps or worsens constipation for one person might not affect another. 

Consider keeping a log of foods eaten and bowel movement timing, along with any other notes about symptoms or improvements. Tracking this information can help identify foods to avoid and inform dietary adjustments.

Increase water and fiber

Increasing water intake can prevent constipation and soften stool. Check with a healthcare provider to determine how much water to consume daily.

For people who are already constipated, try drinking extra water. Staying hydrated can be difficult when dealing with other common Ozempic side effects, such as nausea. Experiment with ways to make fluids more palatable, such as adding extra ice or a squeeze of lemon.

Increasing fiber intake is another good strategy for preventing constipation. Fiber helps add bulk to stool, making it easier to pass. Some examples of nutrient-rich, high-fiber foods include:

• Fruits (e.g. berries, grapes, bananas, peaches, plums, apricots)

• Vegetables (e.g. leafy greens, broccoli, green beans, Brussels sprouts, asparagus, celery)

• Legumes (e.g. peas, beans, chickpeas, lentils) 

• Nuts and seeds (e.g. walnuts, almonds, chia seeds, flaxseeds)

• Whole grains 

Eating high-fiber foods makes it even more important to stay well-hydrated. Fiber pulls more water into the intestines, which can lead to dehydration without adequate fluid intake. Aim for a few extra refills of water or other non-sugary beverages.

Exercise

Ozempic is meant to be used alongside regular exercise, which is not only beneficial for managing type 2 diabetes and weight loss, but also relieves constipation.

Increasing physical activity is a well-known strategy for managing constipation. Try going for a walk. You can also try stretching, yoga, or gently massaging your abdomen. Physical activity can improve colon motility, and the movement from exercise can mechanically stimulate the gut.

Take over-the-counter laxatives or stool softeners for constipation

Over-the-counter (OTC) laxatives and stool softeners are available to treat constipation. Examples include:

• Polyethylene glycol (Miralax)

• Bisacodyl

• Sennosides 

• Docusate

Consult a pharmacist or healthcare provider to determine which laxative or stool softener is safe to use, and follow the label's directions carefully. 

Laxatives sometimes cause a bowel movement within 15 minutes to 6 hours, but check the specific product label for expected timing. These products work in different ways, so talk to a healthcare provider when unsure which one to use.

Some people need to take over-the-counter medications to manage GI side effects during the initial phase of Ozempic treatment, but these should not be a long-term solution. If GI side effects, such as constipation or intolerable nausea, keep recurring, talk with a healthcare provider. They may need to adjust the Ozempic dose or recommend a different treatment.

Adjust bathroom habits

Timed bowel training can help get the bowels on a more regular schedule. To do this, set aside regular times to sit on the toilet every day. When trying to have a bowel movement, avoid straining too hard, with no more than five minutes of moderate effort. Aim for times of day when bowels are naturally more active, such as 30 minutes after meals or after waking up.

Even with timed bowel training, it is still important to go whenever the urge arises. Ignoring the urge to use the bathroom can make constipation worse.

Constipation from semaglutide (the active ingredient in Ozempic) is usually temporary, typically lasting about six weeks. Constipation and other GI side effects usually start during the first four weeks of Ozempic treatment but can begin anytime within the first four months. Constipation may last longer than other GI side effects of Ozempic, such as nausea.

To help minimize side effects, treatment typically starts with a low dose of Ozempic. A healthcare provider may then increase the dose every four weeks or so, depending on how well the medication is tolerated. Gradually increasing the dosage is intended to minimize side effects and help the body adjust to the medication's effects, including constipation.

Contact a healthcare provider right away if your constipation is accompanied by severe stomach pain, swelling in your abdomen, rectal bleeding, loss of appetite, inability to pass gas, and/or vomiting. These symptoms could indicate a more serious issue. 

Pay attention to how often bowel movements occur while using Ozempic, and let a healthcare provider know if constipation does not improve with the recommended management strategies. They may temporarily lower the dose or recommend other ways to treat the symptoms.

See if you qualify

Constipation is a relatively common side effect of Ozempic, due to the way the medication works. 

• Since Ozempic slows gastric emptying, reduces gastrointestinal motility, and may decrease fluid intake, it may cause constipation.

• Ozempic constipation may last around six weeks. However, GI side effects such as constipation can occur anytime within the first four months of taking the medication.

• Ozempic constipation can be managed by avoiding low-fiber foods, increasing high-fiber food intake, drinking more water, exercising regularly, trying over-the-counter stool softeners or laxatives, and practicing timed bowel training.

• Severe stomach pain, abdominal swelling, loss of appetite, inability to pass gas, rectal bleeding, or vomiting warrant contacting a healthcare provider. These symptoms could be a sign of a more serious issue.