Ostomy and Ozempic: Managing Low Output Issues

Hey guys!! So I'm still new to the whole ostomy lifestyle. I'm currently on Ozempic for my diabetes and weight loss. I have been experiencing very low output sometimes for a couple of days in a row. I'm finding myself taking a laxative every other day or every two days to keep movement. I also take a fiber supplement and a digestive enzyme. My question is this... Is anyone else experiencing or has experienced this, and if so, what have you done to help it?

First off, what kind of ostomy do you have?

I wouldn't be too concerned with low output from a colostomy, though you really need to discuss with your doctor about the side effects. Eat more fiber and add a fiber supplement if you aren't already.

If it's an ileostomy, I am not in a position to advise much. But I do think low output like you describe from an ileostomy is greatly concerning and needs medical advice ASAP.

Yeah, if you have an ileostomy, taking a laxative may not be the answer. Are you eating regularly and healthy amounts? I've heard some people say they can only eat 2 or 3 bites of food at a time on that drug. If you are only eating a couple of bites of food, this may be why you have such low output. You have to put something in to get something out. Be sure you are keeping hydrated too. Those kinds of drugs are hard on kidneys, and you need to be mindful of your hydration with an ostomy as well. So that is double the reason to stay hydrated.

If you have an ileostomy, then your lack of consistent output is a concern. If you have a colostomy, then you shouldn't be too concerned. Ozempic curbs your appetite, so you are not eating much — if you are not eating much, you won't have much output. One of the side effects of Ozempic is constipation, so you have to pay close attention to your output. Long-term use of a laxative is a bad idea since your intestinal motility gets compromised and you become dependent on the laxative.

Ozempic side effects are just as applicable to ostomates as anyone else. The side effects must be seriously considered if you have an ileostomy.

The side effects are:
■ Nausea
■ Diarrhea
■ Vomiting
■ Constipation
■ Abdominal pain
■ Ileus
■ Pancreatitis

Nausea, diarrhea, and vomiting can lead to complications like dehydration or electrolyte imbalances. Severe dehydration can lead to kidney problems or kidney failure.

Ozempic's slow gastric emptying and intestinal motility can lead to constipation and partial blockages. It also might alter stool consistency and frequency of output, depending on the type of ostomy and individual digestive function. Ostomates with an ileostomy may experience thicker or more solid output, while those with a colostomy might notice changes in bowel habits.

Ostomates, especially those with an ileostomy, are at higher risk of dehydration and electrolyte imbalances, as they are already at risk for dehydration due to fluid loss through their stoma. Since Ozempic can cause gastrointestinal side effects like nausea, vomiting, or diarrhea, it may exacerbate these risks.

Constipation is a listed side effect of Ozempic, but left untreated, it can lead to far more serious outcomes like ileus, which have the potential to be fatal. The FDA added a warning on Ozempic's label warning about the risk of ileus (blocked intestines).

As with side effects, not everyone experiences any or all of them. Adjusting Ozempic's dosage can help prevent or reduce side effects. Starting with a low dose (e.g., 0.5 mg - 1 mg weekly) and gradually increasing it allows the body to adapt, minimizing digestive side effects like nausea and vomiting. Staying hydrated is very important.

You have to weigh the risk versus the benefit. The use of a GLP-1 is not a weight loss and done activity. Current information suggests that continued use of the GLP-1 is likely necessary to maintain weight loss. However, combining medication with healthy lifestyle changes can play a crucial role in supporting long-term weight management and overall health. Over time, the side effects lessen.

You may also be interested in a thread on Zepbound:
https://www.meetanostomate.org/discussion-forum/viewtopic.php?t=33866

Hi from New Zealand,

I read that you have a colostomy, and it tore at my heartstrings that you are scared to death. Having an ostomy in the beginning can be extremely scary. I can remember when I had my ileostomy 28 years ago that I was frightened and constantly struggling with learning how to cope with my new reality. Fortunately, I had a very supportive husband, which helped a lot.

Like you, I am also diabetic, but I am on insulin.

If you have had your ostomy for only a short time, I am sure that you must have been advised to eat small meals, that it is better to have 6 small meals rather than 3 large ones. To eat slowly and to chew very carefully. And to drink at least 8 to 10 glasses of fluid a day.

Here is a website which I found: https://www.mskcc.org/cancer-care/patient-education/diet-guidelines-people-colostomy

Just know that we are all here for you, so call out if you want to talk to any of us.

Finding this site is the best thing I have done, and everyone is so kind and helpful and caring.

Gracie

My Ostomy Journey: April | Hollister

First, let me say I understand why some need to take a laxative regularly, but I don't understand why people will take a laxative randomly, mess their output normalcy up, then can't figure out why they have output and then none or very little a day or two later. 🤷‍♂️ Hello, you just cleaned your system out, and it'll take a bit of time to build up more output to have regular output intervals. Then, a person thinks they are getting blocked and takes more, starting the cycle all over. My comment wasn't aimed at anyone in particular, just something I've read a few times on various threads over the years. Anyway, carry on….

But the thing is, I am eating daily, so it's going somewhere or nowhere at all.

I'm sorry; I should have clarified that I have a colostomy.

In a normally functioning colon, it can take up to about 2 days for food to get from your mouth to leaving your body. Longer if you are constipated.

Food that is eaten at different meals can clump up together in the colon, which usually does. So there is no clear 1 to 1 correlation between eating and output for anyone possessing a colon (with or without an ostomy).

The more colon you have, the more unpredictable it becomes. Frequent use of laxatives is very bad for your colon and may cause it to stop moving without the laxative. You really need to talk to your doctor about the constipation.

You may be able to take a lower dose and still get the benefit of the medication. People often think that more is better, but it isn't. I write up clinical studies of drugs for a living, and it is obvious from the data that some people benefit more from a lower dose. Everyone is different.

Hi Sarje, what came first, the colostomy or the Ozempic? Does your Ozempic doc know about your colostomy? Whenever I'm prescribed a medication, I always make sure the doctor knows of my ileo because I can't take the med in time-release or coated forms.

Like SusanT said, it can take a couple of days for food to travel through your system with a colostomy since you still have the majority of your digestive tract. Add in if you eat foods that get absorbed better than others, and you may not have much output. Kind of like a dog and good versus bad dog food. If they eat a higher-end dog food that they can absorb, their poop piles are way smaller than if you feed them a cheap brand that's filled with fillers that produce more waste.

If you observe my previous comment, please note that Ozempic slows your stomach from emptying as well as slows your intestinal motility. Since you have a colostomy, it will also slow the frequency of your output. Basically, what you are observing is how your colostomy works with Ozempic.

Ozempic is not the type of medicine you take for a while and quit — this means long-term use of laxatives. By taking laxatives, you are defeating some of the mechanisms that Ozempic uses to facilitate weight loss. You need to stop taking laxatives because you can damage your gut in addition to sabotaging weight loss.

How much Ozempic are you taking? Are you in the 0.5 - 1 mg/week range? Or are you in the higher 2.4 mg/week range?

You are right to be concerned with your infrequent output because Ozempic can lead to constipation. If the constipation remains unchecked, that can lead to ileus. If I were you, I would stop taking the laxative; go on a liquid diet for 2 - 3 days to make sure I don't get constipated when I stop the laxative; gradually start reintroducing solid food to your diet; get an app such as "mySymptoms" or "Eat Smart Kiwi" to track what you eat and how it affects your bowel movements and how fast food moves through your digestive system; finally, try talking with your doctor about readjusting your Ozempic dosage if you are still concerned with constipation.

What fiber supplement and digestive enzyme are you taking? You should not be taking these things to counteract the mechanisms of Ozempic. If you are getting constipated (a side effect of Ozempic), you should lower your dosage and increase it slowly — the side effects will gradually go away.