Does Ozempic make you poop? Yes, Ozempic (semaglutide) commonly affects bowel habits, causing changes in both frequency and consistency of stools. As a GLP-1 receptor agonist licensed in the UK for type 2 diabetes, Ozempic slows gastric emptying and alters gut motility throughout the digestive tract. Clinical trials show gastrointestinal effects are among the most frequently reported side effects, with diarrhoea and constipation both classified as common. Understanding these digestive changes helps patients distinguish normal medication effects from symptoms requiring medical attention, ensuring safe and effective diabetes management.

How Ozempic Affects Your Digestive System

Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus. It is not licensed for weight loss in the UK, although weight reduction may occur as a secondary effect. Understanding how this medication interacts with your digestive system is essential for managing expectations and recognising normal versus concerning side effects.

Mechanism of Action on the Gut

Semaglutide works by mimicking the natural hormone GLP-1, which is released by the intestines after eating. This medication slows gastric emptying—the rate at which food leaves your stomach and enters the small intestine. By delaying this process, Ozempic helps regulate blood glucose levels and promotes satiety, which can aid weight management. However, this fundamental change in digestive transit time directly affects bowel function.

The medication also influences gut motility throughout the entire gastrointestinal tract, not just the stomach. GLP-1 receptors are present along the intestinal wall, and when activated by semaglutide, they can alter the speed and coordination of intestinal contractions. This widespread effect on gut function explains why many patients experience changes in their bowel habits.

Common Gastrointestinal Effects

According to the electronic Medicines Compendium (emc) Summary of Product Characteristics (SmPC), gastrointestinal side effects are among the most frequently reported adverse reactions to Ozempic. These include:

• Nausea (very common, affecting ≥1/10 patients)

• Diarrhoea (common, affecting ≥1/100 to <1/10 patients)

• Vomiting (common)

• Constipation (common)

• Abdominal pain and discomfort (common)

• Dyspepsia (common)

The European Medicines Agency's European Public Assessment Report (EPAR) notes that these effects typically emerge during the initial weeks of treatment or following dose escalation, and often diminish as your body adapts to the medication. The frequency and severity of these effects are generally dose-dependent. The SmPC also notes an increased risk of gallbladder disease, including cholelithiasis.

Does Ozempic Cause Changes in Bowel Movements?

Yes, Ozempic commonly causes changes in bowel movements, though the specific effects vary considerably between individuals. Understanding what constitutes normal variation versus problematic symptoms can help you manage treatment more effectively.

Diarrhoea and Loose Stools

Diarrhoea is one of the more frequently reported side effects of Ozempic, classified as common (affecting ≥1/100 to <1/10 patients) in clinical trials according to the SmPC. This typically manifests as increased stool frequency, looser consistency, or both. The mechanism relates to altered gut motility and changes in fluid balance within the intestines. For most patients, this side effect is mild to moderate in severity and tends to resolve within several weeks as the body adjusts to the medication.

Some patients report that diarrhoea occurs more prominently after consuming fatty or rich meals, though individual responses vary considerably. The delayed gastric emptying may affect how dietary components, including fats, are processed.

Constipation

Conversely, some patients experience constipation whilst taking Ozempic, also classified as common in the SmPC. The slowed gastric emptying and reduced gut motility can lead to harder stools, decreased frequency of bowel movements, and difficulty passing stools. This paradoxical effect—where the same medication causes opposite bowel symptoms in different people—reflects individual variation in gut physiology and baseline bowel habits.

Changes in Frequency and Consistency

Beyond frank diarrhoea or constipation, many patients notice subtler changes such as altered stool consistency (described using the Bristol Stool Chart, types 1-7), different timing of bowel movements, or fluctuations between loose and formed stools. These variations are generally considered normal adaptations to the medication's effects on digestive transit.

While serious bowel complications are rare, the SmPC does note post-marketing reports of intestinal obstruction in some patients. Additionally, GLP-1 receptor agonists including semaglutide are associated with an increased risk of gallbladder disease, which can present with right upper quadrant pain, fever, or jaundice. Monitoring symptoms remains important for identifying any complications.

Managing Digestive Side Effects While Taking Ozempic

Effectively managing gastrointestinal side effects can significantly improve your treatment experience and adherence to Ozempic therapy. The following evidence-based strategies align with NHS and NICE Clinical Knowledge Summaries (CKS) guidance.

Dietary Modifications

Adjusting your diet can substantially reduce digestive discomfort:

• Eat smaller, more frequent meals rather than large portions, which accommodates the delayed gastric emptying

• Reduce dietary fat intake, particularly saturated fats, as these are more difficult to digest when stomach emptying is slowed

• Avoid spicy, heavily seasoned, or fried foods that may exacerbate nausea or diarrhoea

• Increase soluble fibre gradually (oats, psyllium, fruits) if experiencing diarrhoea, as this helps bulk stools

• Stay well hydrated, consuming at least 1.5-2 litres of water daily, especially if experiencing loose stools (note: adjust fluid targets if you have heart failure or chronic kidney disease—consult your healthcare provider for personalised advice)

• Limit alcohol and caffeine, both of which can irritate the digestive system

Timing and Dose Escalation

According to the BNF and SmPC, Ozempic is initiated at a low dose (0.25 mg weekly) specifically to minimise gastrointestinal side effects. This dose is not therapeutic but serves as a tolerance-building phase. After four weeks, the dose typically increases to 0.5 mg, with further escalation to 1 mg if needed for glycaemic control. For patients requiring additional glycaemic control, the dose may be increased to a maximum of 2 mg once weekly. If you experience significant digestive symptoms during dose increases, discuss with your GP or diabetes specialist nurse whether temporarily maintaining your current dose might be appropriate before escalating further.

Symptomatic Relief Measures

For diarrhoea: Over-the-counter loperamide may provide short-term relief, but consult your pharmacist or GP before regular use, as recommended by NICE CKS. Oral rehydration solutions help replace lost fluids and electrolytes.

For constipation: Increase water intake, gentle physical activity, and consider bulk-forming laxatives like ispaghula husk. Stimulant laxatives should only be used short-term and after medical advice, per NHS guidance.

For nausea: Ginger tea, eating bland foods, and avoiding lying down immediately after meals can help. Anti-emetic medications may be prescribed if nausea is severe.

Monitoring and Communication

Keep a symptom diary noting bowel movement frequency, consistency, and any associated symptoms. This information helps your healthcare team assess whether side effects are improving, stable, or worsening, and guides decisions about continuing or adjusting treatment.

When to Seek Medical Advice About Bowel Changes

Whilst gastrointestinal side effects are common with Ozempic, certain symptoms warrant prompt medical evaluation to exclude serious complications or conditions requiring intervention.

Red Flag Symptoms Requiring Urgent Assessment

Contact your GP urgently, call NHS 111, or attend A&E if you experience:

• Severe, persistent abdominal pain, particularly if sharp, constant, or worsening—this may indicate pancreatitis, a rare but serious adverse effect of GLP-1 receptor agonists. According to the SmPC, if pancreatitis is suspected, Ozempic should be discontinued immediately.

• Blood in your stools (visible red blood or black, tarry stools), which could suggest gastrointestinal bleeding

• Persistent vomiting preventing you from keeping down fluids or medications

• Signs of severe dehydration: extreme thirst, dark urine, dizziness, confusion, or reduced urine output

• Severe diarrhoea lasting more than 48 hours, especially with fever or severe cramping

• Symptoms of bowel obstruction: absolute constipation (no stools or wind passed), severe bloating, and vomiting

• Sudden, severe pain in the right upper abdomen, possibly with fever or yellowing of the skin/eyes, which could indicate gallbladder disease

Situations Requiring Routine GP Consultation

Arrange a non-urgent appointment with your GP if:

• Digestive side effects persist beyond 4-6 weeks without improvement

• Bowel changes significantly impact your quality of life or daily activities

• You develop new or unexplained symptoms alongside bowel changes

• Constipation becomes chronic and doesn't respond to lifestyle measures

• You're uncertain whether symptoms are medication-related or indicate another condition

• You're considering stopping Ozempic due to side effects—never discontinue without medical guidance

Monitoring for Pancreatitis

Although rare, acute pancreatitis has been reported with GLP-1 receptor agonists. The SmPC advises patients to seek immediate medical attention if experiencing persistent, severe abdominal pain, often radiating to the back, accompanied by nausea and vomiting. This typically differs from the milder, intermittent discomfort associated with common digestive side effects.

Special Considerations for Dehydration Risk

Severe vomiting or diarrhoea can cause dehydration and potentially worsen kidney function. This risk is higher if you have existing chronic kidney disease or take certain medications like ACE inhibitors or diuretics. Seek prompt medical advice if you're unable to maintain adequate fluid intake.

Regular Diabetes Reviews

Ensure you attend scheduled diabetes reviews where your healthcare team can assess both the efficacy of Ozempic for glycaemic control and the tolerability of treatment. These appointments provide opportunities to discuss any concerns about side effects and explore management strategies tailored to your individual circumstances.

Frequently Asked Questions