Does Ozempic cause constipation?

Ozempic (semaglutide) is a weekly injectable medication that has gained significant popularity for its efficacy in weight loss. However, many people have questions about the side effects of Ozempic, particularly nausea and other gastrointestinal issues. One common question is, "Does Ozempic cause constipation?" and when is it a cause for concern?

The short answer is yes, constipation is a known side effect of Ozempic and other GLP-1 medications like Wegovy and Saxenda. Constipation, characterized by infrequent or difficult-to-pass bowel movements, can put a damper on your daily routines. The good news is that, for most people, constipation from Ozempic is usually temporary and manageable. 

Keep reading to learn more about the connection between Ozempic and constipation, along with practical tips for what to do when you’re constipated and when to seek medical advice.

Constipation is a common side effect of Ozempic. Since its 2017 FDA approval for controlling blood sugar in adults with type 2 diabetes, we’ve known that Ozempic can cause constipation. This side effect is also common with other GLP-1 agonist medications. 

In clinical trials, 5% of people reported being constipated when they injected semaglutide (the active ingredient in Ozempic) 0.5 mg and 3.1% with Ozempic 1 mg. By comparison, only 1.5% of placebo participants reported constipation.

Constipation isn’t the most common side effect of Ozempic, though. Nausea is the most common side effect, affecting more than 20% of people who used the 1 mg dose of Ozempic during clinical trials. Other gastrointestinal side effects reported in studies of Ozempic that were more common than constipation were: 

• Vomiting

• Diarrhea

• Abdominal pain

When prescribing Ozempic, your healthcare provider may suggest that you increase your dietary fiber and water intake before starting the medication, especially if you already have issues with constipation. 

Constipation from semaglutide (the active ingredient in Ozempic) is usually temporary and typically lasts about 6 weeks or 47 days. Constipation and other GI side effects usually start during the first four weeks of Ozempic treatment, but can start anytime in the first four months. Constipation may last longer than other GI side effects of Ozempic, such as nausea. 

To help combat side effects, you’ll use a low dose of Ozempic to start. Then, your healthcare provider may bump up your dose every 4 weeks or so, depending on how well you tolerate the medication. By gradually increasing your dosage, the goal is to minimize side effects and help your body adjust to the medication’s effects, including constipation.

Ozempic may cause constipation for a few reasons. Ozempic works in part by delaying gastric emptying, which is the movement of your stomach contents into your intestines. This effect makes you feel full faster and longer after you eat. You may feel satisfied with less food than usual, compared to before you started Ozempic. 

But that also means you may not drink as much, and your overall fluid intake might decrease. Not drinking enough fluids can make you constipated, with hard, lumpy stools that are difficult to pass. 

GLP-1 agonist medications like Ozempic mimic the effects of a natural hormone called glucagon-like peptide (GLP-1), which has been shown to reduce gastrointestinal motility, aka the movements within the digestive tract. This change may also explain why Ozempic can cause constipation.

Another reason Ozempic can cause constipation stems from another common side effect: nausea. Nausea may also cause you to eat and drink less, leading to hardened stool. Plus, when you feel nauseous and want something to settle your stomach, you might reach for bland foods like saltine crackers or toasted white bread. While these options often help with nausea, they are low in fiber—and not eating enough fiber causes constipation. 

Treating constipation from Ozempic (semaglutide) is crucial 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.

Next, we’ll explore several ways to manage constipation with Ozempic. But if these strategies don’t provide relief, seek medical advice from a healthcare provider to ensure that constipation doesn’t escalate into a more significant health issue.

Foods to avoid

Low-fiber foods can slow digestion and make bowel movements difficult. Adjusting your diet to avoid certain foods on Ozempic can go a long way in helping your bowels move regularly. 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 the foods you eat and when you have bowel movements, and any other notes about symptoms or improvements. Tracking this information can help you pinpoint foods to avoid and adjust your diet accordingly.

Increase water and fiber

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

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

Increasing the fiber in your diet is another good strategy for preventing constipation. Fiber helps add bulk to your stools, making them easier to pass. According to the Dietary Guidelines for Americans, many nutrient-rich foods are high in fiber. Here are a few examples:

• Certain ready-to-eat breakfast cereals, such as shredded wheat and bran flakes

• Popcorn

• Artichokes

• Beans, such as Navy beans, pinto beans, and black beans

• Lentils

• Brussels sprouts

• Sweet potatoes

• Broccoli

When you eat high-fiber foods, it's even more crucial to stay well-hydrated. Fiber pulls more water into the intestines, which can lead to dehydration if you don't drink enough. 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. 

OTC laxatives for constipation

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

• Polyethylene glycol (Miralax)

• Bisacodyl

• Sennosides 

• Docusate

Consult a pharmacist or healthcare professional to determine which laxative options are safe for you, and be sure to follow the label’s directions. Sometimes laxatives cause a bowel movement within 15 minutes to 6 hours, but check the specific product label to know how soon you can expect to have one. These laxatives work in different ways, so talk to your healthcare provider if you are unsure which one to use.

Some people need to take OTC medications to manage GI side effects during the initial phase of treatment with Ozempic, but they shouldn't be a long-term solution. If GI side effects like constipation or intolerable nausea keep coming back, talk with your healthcare provider. They might need to adjust your dose of Ozempic or recommend a different treatment.

Adjust bathroom habits

Timed bowel training can help get your 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, don't strain too hard, with no more than 5 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 when trying timed bowel training, you should still attempt to go anytime you feel the need to go. Ignoring the urge to use the bathroom can make constipation worse. 

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 you have bowel movements while using Ozempic and let your healthcare provider know if constipation doesn’t go away with the recommended management strategies. They may temporarily lower your dose or recommend other ways to treat your symptoms.

Can Wegovy also cause constipation?

Yes, constipation is a common side effect of Wegovy, a weekly weight-loss injection that delivers the same active ingredient as Ozempic. In people with obesity or overweight treated with 2.4 mg of Wegovy, up to 24% had constipation during clinical trials. Constipation may occur more often in people with obesity or overweight than in people with diabetes. 

Can Ozempic cause bowel blockage?

Rarely, cases of bowel blockage, including ileus, have been reported with Ozempic use. These reports led to a labeling safety change by the FDA, adding ileus as a post-marketing side effect to Ozempic’s labeling. Post-marketing means the side effect was reported after the drug became widely available and not during a clinical trial. Even after medications are FDA-approved, side effects continue to be reported to the FDA in the interest of everyone’s safety. Because Ozempic is well known to slow the passage of food through the gut, it’s plausible that ileus can occur in some people who take Ozempic. 

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Current version

July 13, 2024

Written by

Patricia Weiser, PharmD

Fact checked by

Raagini Yedidi, MD

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About the medical reviewer

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.