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semaglutide (Wegovy) and constipation: incidence, timing, management, and when to escalate.
Develops gradually over the first 4-8 weeks. Often persists at maintenance dose because slowed motility is a permanent mechanism, not a transient titration effect.
Same slowed gastric and intestinal motility that drives satiety also slows stool transit. Reduced food intake means less fiber and less stool bulk.
Fiber supplements (psyllium 5-10 g daily), increased water intake (2-3 L daily), regular movement. Magnesium citrate or polyethylene glycol (MiraLAX) as needed. Avoid stimulant laxatives long-term.
No bowel movement for more than 5 days, severe cramping, blood in stool, or constipation paired with vomiting (possible obstruction). Same-day evaluation.
Constipation often outlasts nausea. It is the second-most-cited reason for Wegovy discontinuation at the 6-month mark. Fiber + hydration prevent most cases; do not wait until symptoms appear to start.
Editorial summary, not medical advice. Incidence figures from FDA prescribing information and pivotal trial publications. Individual experience varies. Coordinate side effect management with your prescriber.