STEP 1: Basic Habits for Regular Bowel Movements

I know this sounds basic, but more often than not, when patients come to me constipated on semaglutide, they’re not doing these three simple things: drinking enough fluids, eating enough fiber, and moving enough. I know, easier said than done. But that’s one of the main reasons they’re having symptoms, so start here first.

Fluids

Goal: at least half your body weight in ounces per day
(Example: 160 lb → ~80 oz/day)

Fluids include water, herbal tea, coffee, broth, and other low-sugar drinks.

Increase fluids if you are active, in hot weather, eating more fiber, or constipated. Your body needs extra water to keep stools soft and help fiber work properly.

Fiber

Most women need about 25 grams of fiber a day. The Academy of Nutrition and Dietetics recommends 14 grams for every 1,000 calories you eat, so your exact number depends on how much you eat.

Aim to include fiber foods throughout the day, such as fruits, vegetables, beans, lentils, whole grains, nuts, and seeds.

Many people taking semaglutide naturally eat less, which can also mean less fiber and less stool volume. This is one reason constipation can happen during treatment.

Fiber works best with enough fluids. Increase slowly to avoid bloating and support softer, easier-to-pass stools.

For a complete list of high-fiber foods, see this blog post.

Movement

Follow standard physical activity guidelines:

• At least 150 minutes per week of moderate activity (or 75 minutes vigorous, or a mix)
• Muscle-strengthening activities at least 2 days per week
• Less sitting, with light movement throughout the day

Movement helps the muscles in your intestines work better and supports more regular bowel movements.

STEP 2: Foods for Constipation

Some foods work wonders for constipation. They’re gentle, natural, and easy to find. Hospitals keep prune juice on hand for patients with constipation for a reason.

Goal: Stimulate bowel movements using food and natural triggers

Prune Juice (First Choice)

Prune juice is one of the most studied natural remedies for constipation. It contains fiber and sorbitol, which help draw water into the intestines and make stool softer.

In clinical studies of people with chronic constipation, daily 100% prune juice improved hard stools within 3 weeks, with most people seeing more regular bowel movements by 7 weeks.

You can also use whole prunes for similar benefits.

• Start with about 4 oz daily
• Best taken in the morning or evening
• Increase slowly if needed

Apple or Pear Juice (Gentle Options)

Apple and pear juice can help with mild constipation. They contain natural sugars that can also help to soften your stools. Whole fruit also helps because of fiber.

• Choose 100% juice when possible
• Start with small servings
• Whole fruit is also a good option

Coffee or Tea (Morning Support)

Coffee and warm tea can help stimulate the colon, especially in the morning. This is due to caffeine and the natural gut reflex after warm liquids.

• Coffee, green tea, or black tea may help
• Best used in the morning
• Avoid excess caffeine to prevent dehydration

Kiwi (Natural Gut Support)

Kiwi has been shown to support regular bowel movements. It contains fiber and an enzyme called actinidin that may help digestion.

• 1–2 kiwis per day may help
• Can be eaten with or without skin

Olive Oil (Gentle Stool Softener)

Olive oil may help soften stool by acting as a mild lubricant in the intestines.

• About 1 tablespoon per day
• Can be taken alone or mixed into food

STEP 3: Over-the-Counter Supplements

I often encourage my patients to keep the gentler options, like fiber supplements, on hand and use them on days when they can’t get enough fiber from food. The others, like magnesium and stool softeners, are for when constipation is starting to cause more problems.

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Fiber Supplements

Options include:

• Psyllium Husk
• Methylcellulose
• Inulin-based fibers
• Partially hydrolyzed guar gum (Sunfiber®)*

Important: Take fiber with enough water.

• Always take with a full glass of water
• Start low and increase slowly

Magnesium

Magnesium helps pull water into the intestines, softening stool and making it easier to pass. Magnesium citrate* is the form most often used for constipation.

• Start with a low dose
• Take in the evening
• May work overnight
• Avoid if you have kidney disease unless approved by your provider

Stool Softeners

• Docusate sodium (Colace®)

These help pull water into stool and make it easier to pass.

Remember to drink plenty of fluids if you are taking fiber supplements.

Important note: Check with your healthcare provider if you have kidney disease, chronic conditions, or are taking other medications.

STEP 4: Short-Term Medication Support (Rescue Only)

I think of these as the rescue team. They work, and sometimes you need them, but they’re not meant to become part of your daily routine. If you find yourself reaching for them often, that’s a sign Steps 1 to 3 need more attention, and it’s time to check in with your provider.

Use this step if constipation does not improve after Steps 1–3, or if you go about 3 days without a bowel movement and feel uncomfortable.

Goal: Fast relief while avoiding dependence

Osmotic Laxatives 

These pull water into the intestines to soften stool.

• Polyethylene glycol (MiraLAX®)
• Magnesium-based laxatives (if appropriate)
• Take once daily as directed
• Drink plenty of fluids
• May take 1–3 days to work

Stimulant Laxatives (Rescue Only)

These help the intestines contract and move stool.

• Senna (Senokot®)
• Bisacodyl (Dulcolax®)

How to use:

• Use only short-term
• Take the lowest effective dose
• Stop after a bowel movement
• Avoid regular use
• Stay well hydrated

Overuse can lead to dependence and make constipation harder to manage.

STEP 5: When to Contact Your Healthcare Provider (Red Flags)

Always bring up constipation at your regular visits with the provider who prescribes your GLP-1, even when it feels manageable. But if you have any of the symptoms below, don’t wait for your next appointment. Call their office.

• No bowel movement for 3–4 days with discomfort despite treatment
• Severe or worsening abdominal pain
• Vomiting or ongoing nausea
• Inability to pass gas
• Worsening bloating despite treatment

Do not continue self-treatment if these symptoms occur. You may need medical evaluation or a change in your plan.

Conclusion

Constipation on semaglutide is common, but it is usually manageable with the right step-by-step approach. Most people improve by focusing on fluids, fiber, movement, and adding targeted foods or supplements when needed.

Small, consistent changes often make the biggest difference.

Want personalized support for your GLP-1 journey?

I accept insurance and work with women over 45 on GLP-1 medications every day. Click here to book a 1:1 appointment or explore more resources, recipes, and guides — including The GLP-1 Kitchen cookbook.