If you're an adult receiving semaglutide, such as Wegovy®, or tirzepatide, such as Zepbound®, for weight management and are "a bit backed up," it's important to understand how to manage constipation and what symptoms require urgent care. Here's what to know.
What to know about constipation
Constipation occurs when stool is difficult to move through the digestive tract. Symptoms of constipation can include having fewer than three bowel movements in a week, straining to have a bowel movement, hard or lumpy stool, or feeling like you're not emptying your whole bowel during a bowel movement. It's possible to be constipated even if you're having a bowel movement daily if your stool is hard or you're straining to have a bowel movement.
If you're experiencing any of the above symptoms of constipation, plus any of the following, seek prompt medical assessment (urgent care for severe symptoms): constant or severe belly or intestinal pain, vomiting, inability to pass gas, blood in the stool, and/or fever. Do not try to manage these symptoms at home.
How common is constipation with Wegovy® or Zepbound®?
Constipation was reported in people receiving semaglutide at the Wegovy 2.4 mg once-weekly injection dose in weight-management clinical studies in adults. Overall, 24% of people receiving Wegovy reported constipation, compared with 11% of people receiving a placebo.
Constipation was also reported in people receiving tirzepatide in two clinical studies for weight-reduction in adults. Overall, constipation was reported in 11% to 17% of people receiving Zepbound at the 5 mg, 10 mg, or 15 mg doses compared with 5% of people receiving a placebo.
The Wegovy and Zepbound clinical studies had different designs and participants. Comparing the percentages of people who reported constipation in the Wegovy and Zepbound studies does not tell us which treatment is easier on your gastrointestinal (GI) system. Also, whether or not you're experiencing constipation doesn't predict whether Wegovy or Zepbound will be effective for you.
Why constipation can develop during treatment
If you're taking Wegovy or Zepbound for weight management, constipation can be due to many different factors including decreased gut movement, what you're eating, how much fluid you're drinking, other medications and supplements, and/or changes in activity level. Wegovy and Zepbound delay stomach emptying; constipation also involves movement of stool through the bowel. Some other medications or supplements can contribute to constipation, such as opioid pain relievers and iron supplements. Ask your clinician or pharmacist about constipation from any of your current medicines. Don't stop taking any of your other medicines or supplements without first talking to your care team.
How can I manage mild constipation while using a GLP-1 medication?
Increase your fluid intake as tolerated. How much fluid intake you need varies from person-to-person. Follow any fluid restrictions recommended by your doctor, especially if you have heart or kidney disease. Don’t assume a water target from the internet is right for you.
Work with your registered dietitian to add fiber-rich foods that you enjoy. Remember that introducing too much fiber all at once can make your tummy feel worse. Adding more fiber works best if it's a gradual change paired with adequate fluid intake. Fiber-rich food options include oatmeal, pears, berries, beans, vegetables, and more. If Wegovy or Zepbound are helping you lose weight, it's common to feel less appetite. Rather than drastically change what's in your diet, consider making a few small changes to foods you're already enjoying. Talk to your doctor before starting a fiber supplement, especially if you’ve been struggling to eat enough due to feeling full sooner with GLP-1 medications.
Ask your prescriber if you can use an over-the-counter laxative to help with constipation, especially if you have any underlying conditions. Polyethylene glycol 3350 is one option your doctor may recommend for constipation. This type of laxative, called an osmotic laxative, helps the stool hold onto water to make it easier to pass. This type of laxative may not work right away and may take a few days. Other laxatives can be helpful as well. For example, laxatives containing magnesium should be used with caution, or not at all, if you have kidney disease. Always let your prescriber or pharmacist know what medications you’re on before using laxatives.
Try to get out of the house and take a walk if your care team says it’s OK. You don’t have to do anything strenuous but even a short walk may help you have a bowel movement.
Set aside time to go to the bathroom. Our digestive tract can be stimulated after eating. Try to go to the bathroom after breakfast if you’ve been struggling to have a bowel movement. Don’t linger on the toilet and avoid straining as much as possible. Using a small step-stool under your feet to bring your knees above your hips may help with bathroom positioning.
What to tell your care team
Call or contact your provider if constipation is getting worse or affecting everyday activities. Never skip doses of your GLP-1 or change the timing of your doses unless directed to do so by your prescriber. Do not experiment with different dosing options listed online.
Keeping track of side effects may be helpful during visits with your doctor. Write down when you received your injection and any dose increases. Keep track of how often you’re having a bowel movement and what they’re like, such as liquid, soft, hard, or painful. Jotting down other symptoms, what you’ve already tried, other medicines and any changes in diet could be helpful as well.
Call your doctor if constipation has been occurring after increasing your dose of GLP-1 medication. Your prescriber may recommend a change in your dose titration or other treatment options.
If constipation continues, questions to discuss with your clinician include:
Are there other possible causes of constipation in addition to Wegovy or Zepbound, including diet and exercise?
Are there prescription options that can help with constipation?
Should you be using laxatives, and, if so, which ones?
Is it necessary to reduce your dose of Wegovy or Zepbound?
Should you be referred to a GI specialist?
When constipation needs urgent attention
Seek immediate medical attention if you have:
Constant or severe abdominal or stomach pain with constipation
Vomiting with constipation
Marked or worsening swelling of the abdomen
An inability to pass gas
If you’re experiencing severe symptoms such as vomiting, inability to tolerate fluids, severe dizziness or light-headedness, or decreased urination, it’s important to contact your doctor for prompt medical care.
The labels for semaglutide and tirzepatide list reports of ileus, intestinal obstruction, and severe constipation including fecal impaction after the medicines reached the market. These reports cannot reliably establish how often the problems occur or whether the medicine caused them. If you have a bowel obstruction or impaction, you may not be able to have a bowel movement, have abdominal pain, vomit, and/or be unable to pass gas. Always let your care team know right away if you’re having any of these symptoms before taking fiber supplements or laxatives.