Introduction

Have you recently started taking a GLP-1 weight loss medication, such as Ozempic, Wegovy, Zepbound, Mounjaro, semaglutide, or liraglutide, and noticed unexpected bowel changes? If constipation, bloating, or irregular bowel movements have become a new obstacle outside of weight loss, —you’re not alone. As a Doctor of Physical Therapy who is Dual Board Certified in Pelvic Health (WCS and PRPC), I’ve worked with many patients facing these bowel challenges. In this article, I’ll shed light on why these bowel changes occur and show you how pelvic floor physical therapy can help. By the end, you’ll have a clear understanding of the some actionable steps you can take to alleviate these uncomfortable symptoms and improve your overall digestive health, all while continuing on your weight loss journey.

Section 1: The GLP-1 Bowel Connection

Why Bowel Changes Happen with GLP-1 Medications

GLP-1 (Glucagon-Like Peptide-1) medications are popular for promoting rapid weight loss and better blood sugar control. Ozempic, Wegovy, Zepbound, Mounjaro, semaglutide, and liraglutide all work in similar ways to help regulate insulin and reduce appetite. However, these drugs can also slow down stomach emptying and alter gut motility. What does this lead to? Constipation, bloating, or irregular bowel movements.

Common Symptoms and Challenges

1. Constipation: Many patients report straining during bowel movements or reduced frequency of bowel movements.

2. Bloating: Slower stomach emptying and gut motility can lead to a build up of gas causing a feeling of fullness and abdominal distention.

3. Firmer stools: The slower gut motility causes water from the stool to be reabsorbed in the colon making stools firmer and more difficult to pass.

4. Incomplete emptying: A sensation of not being able to fully evacuate can be caused from the slow motility combined with harder stools and pelvic floor incoordination.

For those who are already prone to digestive issues—or for those who have a pre-existing pelvic floor issue like pelvic organ prolapse, pelvic pain, or incontinence —these challenges can intensify.

The Pelvic Floor Connection

What does the pelvic floor have to do with bowel changes? Quite a bit, actually. The pelvic floor muscles support your internal organs like the bladder, uterus (in women) or prostate (in men), and rectum. Additionally these muscles also support other systems like your back, hips, or abdominal muscles.

GLP-1 medications can influence this in two ways: they slow gut motility, and weight loss affects the structure of the body, which in turn can impact the functioning and support of these muscles. As a result, the pelvic floor muscles may become overly tight, either in an attempt to better support the core or due to constipation. Understanding this interplay is essential for addressing these symptoms and getting you back to feeling good.

Section 2: Steps You Can Take Now

Practical Strategies for Immediate Bowel Relief

1. Proper Hydration
   Ensuring you are hydrating with enough fluids can help soften stools and facilitate healthy bowel movements. A good rule of thumb is to aim for at least 8 cups of water per day.

2. Increase Dietary Fiber Slowly
   While fiber is your friend for improved bowel regularity, introducing too much, too fast can worsen bloating. Gradually increase your daily fiber intake with vegetables, fruits (with skin), and whole grains.

3. Practice Proper Toilet Posture
   Believe it or not, how you sit on the toilet matters. Using a small footstool or a squatty potty, will elevate your feet to better align the rectum for easier bowel evacuation, reducing the need for straining.

4. Incorporate Gentle Pelvic Floor Relaxation
   Oftentimes, bowel problems stem from pelvic floor tension. Simple relaxation exercises, such as deep diaphragmatic breathing or gentle stretches like the happy baby pose or child's pose, can help calm the muscles involved in bowel movements.

5. Create a “Bowel Routine”
   The gut thrives on regularity, and our emptying reflex is usually strongest in the morning. Creating a morning routine where you wake up at a similar time, eat breakfast, drink something warm, and incorporate movement can help stimulate your gastrocolic reflex and give your bowels a predictable pattern.

Small Changes, Big Impact

Implementing these strategies often leads to improvements in bowel regularity. However, every body responds differently. Individualized guidance from a pelvic health professional can ensure you’re taking the right steps that your particular body needs, especially if you have chronic symptoms or a known pelvic floor issue.

Section 3: Why Pelvic Floor Physical Therapy Works

How Pelvic Floor Therapy Can Help Relieve Bowel Issues

As a Doctor of Physical Therapy with dual board certifications in pelvic health (WCS and PRPC), I specialize in identifying and treating the underlying issues that affect bowel function. While you can't stop the physiological effects of the GLP-1 medication on your body, you can influence the other aspects of gut health, which is multifaceted.

Here’s how pelvic floor therapy can help:

1. Thorough Evaluation
   We’ll assess your overall health, any pre-existing conditions, and how your new weight loss medication impacts your daily life. We’ll also review your lifestyle, stress levels, and typical dietary patterns.

2. Pelvic Floor Muscle Assessment
   Using external and (if appropriate) internal assessments, we’ll identify specific muscle imbalances, tension, or weakness in your pelvic floor that may exacerbate bowel movement difficulties.

3. Coordination Training
   Learning to coordinate and relax the pelvic floor muscles can help with complete bowel evacuation, especially if tension is contributing to constipation.

4. Stabilization and Strengthening Exercises
   Based on your individual assessment, we’ll design a regimen of exercises that not only better support your core but also help support your pelvic floor to improve your bowel health.

5. Hands-On Manual Techniques
   Manual therapy techniques can relieve tension in the muscles, fascia, and connective tissues around the pelvis. Techniques like colon massage, especially to the abdomen, can also help stimulate the gastrocolic reflex.

6. Holistic Lifestyle Recommendations
   Beyond direct physical therapy techniques, you’ll receive guidance on diet, hydration, and stress management, all of which directly influence gut regularity and health.

Maintaining Momentum

Pelvic floor therapy isn’t just a one-time fix. By combining hands-on therapy, practical home exercises, and lifestyle strategies, many patients see steady improvement that can last well beyond the therapy sessions. The key is consistent practice and periodic check-ins with your provider to maintain progress.

Conclusion

Key Points

• GLP-1 medications (Ozempic, Wegovy, Zepbound, Mounjaro, semaglutide, liraglutide) can offer effective weight loss, but cause side effects of bowel changes like constipation, bloating, and irregularity.

• Pelvic floor dysfunction can intensify these symptoms, making bowel movements more difficult.

• Pelvic floor physical therapy provides a holistic, non-invasive way to address specific muscle imbalances in areas surrounding the stomach, colon, and rectum to relieve discomfort.

If bowel changes are taking a toll on your weight loss journey or your daily life, don’t settle for feeling uncomfortable. Pelvic floor physical therapy can bring you the relief you need while helping you stick to your GLP-1 medication plan.

Ready to take control of your digestive health? Schedule an appointment with our pelvic floor physical therapy team today. We’ll create a customized plan that meets your specific needs, ensuring you feel supported and confident every step of the way.

Written by:

Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health

Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.

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