How do I relieve constipation on semaglutide or tirzepatide?

Start with hydration, gradual soluble fiber, and daily movement, then add an osmotic laxative like polyethylene glycol (PEG 3350) if needed. Seek urgent care for severe abdominal pain, persistent vomiting, or inability to pass gas.

Why do GLP-1 medications cause constipation?

They slow gastrointestinal transit, so more water is absorbed from stool in the colon. That can lead to harder, drier stools—especially during dose increases.

Is constipation common on semaglutide and tirzepatide?

Yes. Constipation is a common, dose-related side effect and is often most noticeable during dose escalation, then improves as the dose stabilizes.

How much water should I drink to help GLP-1 constipation?

Hydration should be intentional because thirst cues can be blunted on GLP-1 therapy. If you increase fiber without enough fluids, constipation can worsen.

How do I add fiber without making constipation worse on a GLP-1?

Start low and go slow: begin around 5 grams/day and increase gradually over 1–2 weeks while increasing fluids. Many people do best aiming for roughly 25–38 grams/day total fiber from food plus supplements as needed.

What fiber supplement is best for GLP-1 constipation?

Soluble, gel-forming fiber (like psyllium husk) is often helpful, and methylcellulose is another option. Increase the dose gradually and pair it with adequate fluids.

What exercise helps constipation on GLP-1 medications?

Regular movement helps stimulate bowel motility. A practical target is about 150 minutes/week of moderate activity, such as walking.

What is the best over-the-counter laxative for GLP-1 constipation?

Polyethylene glycol (PEG 3350) is commonly used first because it draws water into stool and is generally well tolerated. It’s often preferred over stimulant laxatives for ongoing management.

When should I use a stimulant laxative like senna or bisacodyl?

Use stimulant laxatives for short-term “rescue” if needed, not as a daily long-term plan. They can cause cramping and, if overused, may contribute to dehydration or electrolyte issues.

Can magnesium help constipation on GLP-1 medications?

Magnesium oxide is an osmotic option mentioned in constipation guidance. Avoid or use only with clinician guidance if you have kidney disease or are at higher risk for electrolyte problems.

Does docusate (Colace) work for constipation?

Usually not very well. Evidence shows minimal benefit, and it’s generally not a first-line option compared with fiber or osmotic laxatives.

How long does GLP-1 constipation last?

It often improves after a few weeks once your dose is stable, but it can flare again after dose increases. A small daily maintenance plan (hydration, fiber, and sometimes PEG 3350) may help prevent recurrence.

When is constipation on semaglutide or tirzepatide not normal?

It’s not normal if you have severe abdominal pain, significant bloating with tenderness, persistent vomiting (especially undigested food), or you cannot pass stool and gas. Those can be signs of obstruction and need urgent evaluation.

Is bowel obstruction a risk with GLP-1 medications?

The article notes observational research suggesting a higher relative risk compared with some other weight-loss medications, but the absolute risk is low. Severe symptoms—especially inability to pass gas or stool with pain or vomiting—require urgent care.

Constipation on Tirzepatide or Semaglutide (GLP-1): A Step-by-Step MD Fix

Joshua Silva, MD
2 days ago
5 min read

Updated: 1 hour ago

Medically authored by Joshua Silva, MD | Evidence-Based Weight Loss at Potere Health MD

Definition

Constipation on GLP-1 medications refers to infrequent, hard, or difficult-to-pass stools caused by medication-related slowing of gastrointestinal motility.¹

The Quick Fix: How do I relieve constipation on GLP-1 medications?

Answer:To relieve constipation on semaglutide or tirzepatide, increase fluid intake, gradually add soluble fiber (such as psyllium husk), remain physically active, and use an osmotic laxative (such as polyethylene glycol) if needed. Seek urgent medical care if you develop severe abdominal pain, persistent vomiting, or an inability to pass gas.²,⁷

Why do tirzepatide and semaglutide cause constipation?

The science of slowed gastrointestinal motility

GLP-1 receptor agonists act on the gut–brain axis and are known to slow gastric emptying and overall gastrointestinal transit, contributing to early satiety and appetite suppression.¹

As intestinal transit slows, the colon has more time to absorb water from stool, leading to hard, dry stools that are difficult to pass.¹

Constipation is a common, dose-related adverse effect listed in FDA prescribing information for both Wegovy® (semaglutide) and Zepbound® (tirzepatide) and is most frequently reported during dose escalation, with improvement over time.²,³

Step-by-Step MD Protocol for Relief

1. Hydration = lubrication

GLP-1 medications may blunt thirst cues. Patients should intentionally hydrate, aiming for adequate daily fluid intake consistent with national hydration guidelines, adjusted for body size and activity.⁴

⚠️ Key point: Fiber without adequate fluid intake can worsen constipation by increasing stool bulk without improving passage.

2. Strategic fiber titration (not fiber loading)

Avoid abruptly starting high-dose fiber, which commonly causes bloating and discomfort.

Preferred options

Psyllium husk (soluble, gel-forming)
Methylcellulose (non-fermentable)⁵

Method:

Start at ~5 g daily and increase gradually over 1–2 weeks, ensuring adequate hydration.⁵
Over time, many patients do best aiming for ~25–38 g/day of total fiber from a combination of dietary sources and supplements, rather than supplements alone

Clinical note: Some patients benefit from a small daily “maintenance” fiber dose long-term to remain regular while on GLP-1 therapy.

3. The “movement” stimulus

Physical activity stimulates colonic contractions and supports bowel regularity.

Target: ~150 minutes of moderate activity per week, including walking and light core movement.⁶

4. Osmotic vs stimulant laxatives (OTC options)

First-line pharmacologic option:

Polyethylene glycol (PEG 3350) is recommended by gastroenterology guidelines because it increases stool water content, improves stool frequency, and is generally well tolerated for ongoing use.⁷

Alternative osmotic option:

Magnesium oxide may help some patients and is conditionally recommended in gastroenterology society guidance. It should be avoided or used only under clinician supervision in patients with kidney disease, older adults, or those at risk for electrolyte abnormalities, due to the risk of hypermagnesemia.⁷,¹⁰

Use sparingly: Stimulant laxatives (such as bisacodyl or senna) may be effective for intermittent rescue use, but they can cause cramping and are generally not needed for routine long-term management when osmotic agents are effective.⁷,⁸

⚠️ Safety note: Regular stimulant laxative use that causes frequent loose stools may contribute to dehydration and electrolyte imbalance (including hypokalemia) and should therefore be intermittent unless clinician-directed.⁸

What about docusate (Colace)?

Docusate is widely used, but clinical trials have not demonstrated meaningful benefit over placebo and it is less effective than fiber or osmotic laxatives. Gastroenterology guidelines therefore do not recommend docusate as a first-line treatment when more effective options are available.⁷,¹¹

How long does constipation last on GLP-1 medications?

For many patients, constipation improves within the first few weeks as the dose stabilizes and the body adapts. Symptoms may recur temporarily after dose increases and usually respond to hydration, gradual fiber titration, and dose pacing. Some patients benefit from a small daily maintenance fiber dose (and, in some cases, polyethylene glycol) to remain regular while on therapy.²,⁷

When is constipation a medical concern?

Observational data suggest a higher relative risk of bowel obstruction among individuals using GLP-1 receptor agonists for weight loss compared with some other anti-obesity medications, though the absolute risk remains low.⁹

Seek urgent medical care for these red flags

Persistent vomiting, particularly of undigested food
Severe abdominal distension with pain or tenderness
Obstipation: complete inability to pass both stool and gas for >72 hours

When constipation needs physician-guided management

The MD advantage

We don’t just prescribe—we actively manage side effects. At Potere Health MD, we individualize titration speed, adjust dosing when needed, and use evidence-based strategies so treatment remains safe, tolerable, and effective.

For patients whose constipation is limiting adherence or quality of life, individualized medical management often makes the difference between stopping therapy and long-term success.

👉 Consult with an MD at Potere Health MD for a personalized plan

Disclaimer

This article is for educational purposes only and is not a substitute for medical advice.

About the Author

Dr. Joshua Silva, MD, is a licensed physician and Medical Director of Potere Health MD. He earned his medical degree from the University of Hawaiʻi John A. Burns School of Medicine and completed residency training in Occupational and Environmental Medicine at the University of Utah, where he also earned a master’s degree in Occupational Health. He later completed a Master of Business Administration with an emphasis in health care administration at Ohio University.

Dr. Silva specializes in evidence-based weight management, including GLP-1 and GIP therapies such as semaglutide and tirzepatide. He provides in-person and virtual care for patients in Salt Lake City, St. George, and Cedar City, Utah.

References

Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab.2018;27(4):740-756. https://pubmed.ncbi.nlm.nih.gov/29617641/
Novo Nordisk Inc. Wegovy® (semaglutide) injection: prescribing information. 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/215256s024lbl.pdf
Eli Lilly and Company. Zepbound® (tirzepatide) injection: prescribing information. 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/217806Orig1s020lbl.pdf
National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. National Academies Press; 2005. https://nap.nationalacademies.org/catalog/10925
McRorie JW. Evidence-based approach to fiber supplements and clinically meaningful health benefits. Nutr Today. 2015;50(2):82-89. https://journals.lww.com/nutritiontodayonline/fulltext/2015/03000/evidence_based_approach_to_fiber_supplements_and.8.aspx
Gao R, Tao Y, Zhou C, et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis. Dig Liver Dis. 2019. https://pubmed.ncbi.nlm.nih.gov/30843436/
Chang L, et al. AGA–ACG clinical practice guideline on the pharmacological management of chronic idiopathic constipation. Am J Gastroenterol. 2023. https://pubmed.ncbi.nlm.nih.gov/37211380/
Bharucha AE, Dorn SD, Lembo A, et al. American Gastroenterological Association medical position statement on constipation. Gastroenterology. 2013;144(1):211-217. https://pubmed.ncbi.nlm.nih.gov/23261064/
Sodhi M, et al. Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA. 2023;330(18):1795-1797. https://jamanetwork.com/journals/jama/fullarticle/2810542
Yamaguchi H, Shimada H, Yoshita K, et al. Severe hypermagnesemia induced by magnesium oxide ingestion: a case series. CEN Case Rep. 2019;8(1):31-37. https://pubmed.ncbi.nlm.nih.gov/30136128/
Tarumi Y, Wilson MP, Szafran O, Spooner GR. Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. J Pain Symptom Manage. 2013;45(1):2-13. https://pubmed.ncbi.nlm.nih.gov/22889861/