Struggling With Constipation On A GLP-1 Medication? Pelvic Physical Therapy Can Help

GLP-1 receptor agonists like Ozempic and Wegovy are changing the game when it comes to diabetes and weight management. Researchers are also exploring their potential benefits for things like smoking cessation, substance use disorders, and even polycystic ovary syndrome (PCOS), widening their impact far beyond diabetes and obesity.

But despite all of the promise, GLP-1 medications often come with frustrating gastrointestinal (GI) side effects. For many, constipation is one of the most stubborn and persistent.

Fortunately, there are effective ways to manage GLP-1-related constipation, including support from pelvic floor physical therapy. Keep reading to learn more about GLP-1 medications, how they can lead to constipation, and (most importantly) how to get things moving again.

Understanding GLP-1 medications

GLP-1 (glucagon-like peptide-1) receptor agonists, like semaglutide (the active ingredient in Ozempic and Wegovy), act like the GLP-1 hormone that’s naturally made in your body. 

After you eat (and your blood sugar increases), GLP-1 medications work by helping your body make more insulin while secreting less glucagon. It also slows gastric emptying (how fast food empties from your stomach) and helps you to feel fuller for longer. As a result, GLP-1 receptor agonists can help with blood sugar control if you have Type 2 diabetes and weight management.

But there’s a trade-off. Because GLP-1s can impact how your digestive system works, they often cause a few gastrointestinal (GI) side effects. And for some people, constipation is one of the most persistent.

Do GLP-1 medications cause constipation?

Yes, they can. Constipation is one of several GI side effects linked to GLP-1 receptor agonists, and some research shows that it’s especially common with semaglutide, the active ingredient in both Ozempic (for Type 2 diabetes) and Wegovy (for weight management). Other possible GI symptoms include nausea, vomiting, abdominal discomfort, and diarrhea. 

In clinical trials:

• About 5% of people taking Ozempic reported constipation
• About 24% of people taking Wegovy reported constipation

GLP-1 medications can slow digestion and reduce how often you go, especially in people with a higher body weight. This means that new or worsening constipation isn’t unusual. While it’s generally less common than other GI side effects, constipation may hang around longer and be more disruptive for some.

Luckily, most people find GLP-1-related constipation manageable. Only about 4% of people in studies needed to stop the medication because of their GI symptoms, which suggests that with the right support, relief is possible.

How do GLP-1 medications cause constipation?

Constipation is a common side effect of GLP-1 medications like Ozempic and Wegovy. But why does it happen? While researchers are still learning all the ins and outs, here are the most likely reasons:

• Slowed digestion: GLP-1s delay how quickly your stomach empties into your intestines. That’s great for blood sugar and appetite regulation, but it’s likely impacting the pace of the rest of your digestion, too
• Sluggish gut motility: These meds may also affect how your intestines contract and move food along. When transit time slows (reduced intestinal motility), more water is absorbed from your stool, making it harder, drier, and tougher to pass.
• Changes in eating and drinking habits: Many people naturally eat less while taking GLP-1 medications, which can mean less fiber, different eating habits, and less fluid intake. Add in the fact that some people feel a little “meh” about food or water while on the meds, and you’ve got the perfect recipe for constipation.

It’s always best to mention new or worsening constipation to your prescriber. They can work with you to adjust your dose, switch up your GLP-1 medication, modify your diet, or even recommend other medications to address your bowel symptoms. But there’s another piece to the puzzle that often gets overlooked, and that is your pelvic floor.

The pelvic floor-constipation connection

If you’re not thinking about your pelvic floor when it comes to constipation, it’s time to start.

Your pelvic floor is the group of muscles at the bottom of your pelvis that supports your pelvic organs and helps control when you pee, poop, and pass gas. 

When it comes to bowel movements, these muscles need to release and open to help you poop. And they coordinate with your intestinal movements, abdominal muscles, and breath to allow stool to pass easily and pain free. 

But GLP-1s slow everything down, so stool may sit longer in your colon, meaning your poop gets harder and becomes a lot harder to pass. The natural tendency is to strain. A lot. And the more you strain, the more your pelvic floor muscles tighten, which makes pooping even harder.

Over time, this creates a not-so-fun feedback loop: harder stools → more straining → tighter pelvic floor → even harder stools.

Luckily, your pelvic floor definitely isn’t stuck this way. Pelvic floor physical therapy (PT) can make a big difference.

When to get professional help

While many GLP-1-related constipation cases can be managed with self-care strategies, there are certain times when professional help (like from a pelvic PT) can help you get faster relief. You should consider reaching out (virtually or in person) if you have:

• Not had a bowel movement for more than 3 to 4 days
• Severe abdominal pain or distention
• Blood in your stool
• Constipation that significantly impacts quality of life
• Constipation that doesn't improve with your usual self-management strategies

How pelvic floor physical therapy can help

Pelvic floor physical therapy can be a very helpful tool when managing GLP-1-related constipation. It helps address the muscular and behavioral patterns that may be contributing to your symptoms — especially when straining and incomplete emptying become part of the picture. Whether in-person or through a virtual session your pelvic PT can create a personalized plan to support your bowel health. Below are some core areas pelvic PT often focuses on.

1. Dietary changes

Changes in your appetite and digestion can impact what you eat and drink, which are both essential for regular bowel movements. Your pelvic PT can help you make gradual, sustainable adjustments to your eating habits, including increasing soluble fiber, incorporating healthy fats, and identifying foods that may be making your symptoms worse. 

2. Hydration strategies

GLP-1s can blunt your thirst cues, which makes it easy to unintentionally under-hydrate. Your PT can help you build better hydration habits that support softer stools and easier bowel movements, like setting reminders, adjusting your intake based on activity, and tracking urine color as a hydration cue.

3. Physical activity and movement

Regular movement may be able to support your digestive function, which is why experts commonly recommend exercise for GLP-1-related constipation. Your pelvic PT will work with you to find gentle movement strategies that fit your lifestyle — from short walks to abdominal massage or targeted stretches that encourage gut motility.

4. Toileting posture

The way you sit on the toilet can have a big impact on how easily you poop. Your PT will guide you in finding a more effective position. Usually this means elevating your feet onto a stool, leaning forward slightly, and relaxing your belly. These posture adjustments can help reduce straining and improve emptying.

5. Timing and routine

When you have trouble pooping, it’s important to take advantage of your body’s natural gastrocolic reflex, which is strongest in the morning and after meals. Your pelvic PT will work with you to establish an effective bowel routine that may include certain stretches, timing certain meals, or setting aside some quiet time to sit on the toilet after meals.

6. Breathwork and muscle coordination

Many people with constipation unintentionally contract their pelvic floor during bowel movements, which makes it harder to go. Your therapist may introduce exercises like diaphragmatic breathing or proper pushing techniques to help coordinate your core and pelvic floor muscles. These help to support relaxation, reduce straining, and improve pressure dynamics during a bowel movement.

7. Pelvic floor retraining

In some cases, chronic straining or poor muscle coordination can lead to patterns of tension in the pelvic floor. Your PT may use visualization cues, manual techniques, or biofeedback to help retrain these muscles and support better bowel habits over time.

Getting help at Origin Physical Therapy

Constipation related to GLP-1 medications can be frustrating, uncomfortable, and difficult to manage on your own, especially when pelvic floor dysfunction is involved. At Origin, our pelvic floor physical therapists are trained to assess and treat the unique muscle and movement patterns that can interfere with bowel function.

Whether you're dealing with occasional constipation or a cycle of chronic symptoms, we’re here to help you find relief. Your treatment plan will be tailored to your body, your lifestyle, and your goals — so you can feel better, faster. If you’re ready to get started, book a visit now. You can learn more about your body and symptoms and our approach to pelvic floor physical therapy.

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