I literally have not had a bowel movement in 5 days. I'm on tirzepatide 5 mg, week 6. Before this I was regular as clockwork, every single morning.
I'm bloated, uncomfortable, my appetite is gone (but is that the drug or the fact that I'm full of 5 days of food??), and I'm getting worried. I've tried Miralax for 2 days and nothing.
Is this dangerous? Should I go to urgent care? I've never gone this long without going. 😩
Constipation is a very common side effect — reported in 10-24% of participants in SURMOUNT trials depending on dose. It's a direct consequence of delayed gastric and intestinal transit.
5 days is uncomfortable but not immediately dangerous in most cases. However, I'd want to rule out a few things:
- Any severe abdominal pain (not just bloating)?
- Any vomiting?
- Any fever?
If yes to any of those, get evaluated today. If it's just bloating and discomfort:
- Miralax (PEG 3350): increase to a full dose (17g) daily. Give it 48-72h to work — it's an osmotic laxative, not a stimulant, so it takes time.
- Add a stimulant laxative like bisacodyl (Dulcolax) or senna if Miralax alone isn't cutting it.
- Magnesium citrate (the liquid bottle, not capsules) is the nuclear option and will almost certainly work, but stay near a bathroom.
- Hydration — you need to be drinking significantly more water on GLP-1s. Aim for 80-100 oz/day minimum.
Long-term management: daily fiber supplement (psyllium husk), adequate water, and if constipation persists, discuss prescription options like linaclotide with your provider.
Oh god I remember this phase. I went 7 days once in month 2 and nearly lost my mind. Here's what eventually became my routine:
- Morning: large glass of warm water with lemon, 2 tbsp ground flaxseed mixed in
- Daily: Miralax in my afternoon water
- Nightly: 400 mg magnesium glycinate (gentler than citrate, won't give you the runs)
- Prunes. I know. I'm 34 and eating prunes like a grandma. They work.
It took about 8 weeks on tirz for my gut to recalibrate, and now I go every 1-2 days which for me on this drug, I'll take it.
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Browse GL BiochemCan I just say — nobody warns you about this adequately. My doctor was like "you might get some constipation" like it's a minor inconvenience. NO. It's sitting on the toilet for 30 minutes passing what feels like a boulder. It's the bloating making you look 6 months pregnant. It's the anxiety of "is something actually wrong inside me."
What finally helped me: Smooth Move tea (senna-based herbal tea) every other night. Not every night because you can become dependent on stimulant laxatives. And walking — 30 min walks genuinely help motility.
UPDATE: magnesium citrate worked. I'll spare you all the details but let's just say it WORKED. Aggressively. 💀
Going to start the daily Miralax + magnesium glycinate routine going forward. Thank you all for the advice and for making me feel less alone in this extremely unglamorous side effect.