Glad it resolved. A few additional points for everyone reading this later:
When constipation on GLP-1s requires medical attention:
- No BM for 7+ days despite OTC interventions
- Severe abdominal pain or distension
- Vomiting (could indicate obstruction)
- Blood in stool or rectal bleeding
- Fecal impaction symptoms (constant urge, inability to pass, leaking of liquid stool around impaction)
Also — and I say this gently — make sure you're actually eating enough. Some patients get so focused on appetite suppression that they're consuming <800 calories and barely any fiber. Your colon needs bulk to work with. Even on a GLP-1, aim for 20-25g of fiber daily.
Adding my two cents: a squatty potty (or any footstool that gets your knees above your hips) made a real difference for me. Changes the angle of the anorectal junction. Combined with Miralax it went from "impossible" to "manageable."
Also seconding the walking recommendation. On days I walk 30+ minutes, things move. On days I sit at my desk all day, nothing.
One more underrated tip: warm beverages. Hot coffee in the morning has a well-documented prokinetic effect on the colon. Even if the drug is slowing your GI tract, caffeine and the gastrocolic reflex from warm liquid can help kickstart things. I have a cup of hot coffee within 20 minutes of waking up and it's the most reliable part of my constipation management.
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