Diarrhea vs constipation on GLP-1 — need advice

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.