Ozempic Constipation: Why It Happens and What Actually Helps (2026)

Why Ozempic Causes Constipation: The Pharmacological Mechanism

Semaglutide activates GLP-1 receptors in the stomach, small intestine, and colon, slowing the entire digestive transit. Gastric emptying is delayed by 30 to 40 percent, meaning food sits in the stomach longer before entering the small intestine. Colonic motility is reduced, meaning waste moves through the large intestine more slowly, allowing more water to be reabsorbed and producing harder, drier stool. This is not a side effect you can override. It is an inherent consequence of how semaglutide works.

Understanding this mechanism matters because it determines which interventions will actually help. Constipation caused by slow transit through the colon responds to osmotic laxatives (magnesium citrate, polyethylene glycol) that increase water content in the stool. It does not respond well to bulk-forming agents (fiber) alone, because fiber requires adequate water and motility to work, and GLP-1 medications reduce both.

Clinical trial data from the STEP and SUSTAIN programs show constipation rates of 3 to 5 percent in type 2 diabetes trials (lower doses) and up to 24 percent in weight-management trials (higher doses) ( Kushner et al., 2020). Real-world data suggests the true prevalence may be higher, as clinical trials tend to undercount symptoms that patients consider manageable. One analysis found that constipation on semaglutide lasted a median of 47 days, significantly longer than nausea, which typically resolves within 2 to 3 weeks.

The constipation is dose-dependent. It worsens when increasing from 0.25 mg to 0.5 mg and again from 0.5 mg to 1.0 mg (or 2.4 mg for Wegovy). Many physicians recommend addressing constipation proactively before dose escalation rather than waiting for it to develop.

In a 2026 systematic review evaluating the effectiveness and safety of semaglutide in obese nondiabetic patients, researchers confirmed that gastrointestinal adverse events are the most frequently reported side effects, with constipation, nausea, and diarrhea leading the list ( Naz et al., 2026). A separate 2026 analysis in the Annals of Internal Medicine compared the GI safety profiles of dulaglutide, semaglutide, and tirzepatide, finding that semaglutide had a distinct GI adverse event profile that physicians should account for when selecting treatment ( Crisafulli et al., 2026).

The clinical reality is that most patients who start Ozempic will experience some GI disruption. A 2026 narrative review in the Journal of Nutrition highlighted the emerging concern of malnutrition during GLP-1 therapy, noting that the combined effect of appetite suppression, nausea-driven food avoidance, and slowed absorption creates nutritional deficits that require proactive management, not just reactive supplementation after symptoms appear ( Mogna-Peláez et al., 2026).

Magnesium Citrate: The Osmotic Laxative That Also Fills a Nutritional Gap

Magnesium citrate is the single most recommended supplement for Ozempic constipation because it addresses two problems simultaneously: it draws water into the colon through osmosis (producing softer, easier-to-pass stool) and it provides bioavailable magnesium to a population that is almost certainly not getting enough from food due to dramatically reduced caloric intake.

The osmotic mechanism is straightforward. When magnesium citrate reaches the intestines, a significant portion is not absorbed and stays in the gut lumen. This unabsorbed magnesium creates an osmotic gradient that pulls water from the intestinal wall into the lumen. More water in the colon means softer stool and increased colonic distension, which stimulates peristalsis (the muscular contractions that propel waste forward). This is the same mechanism by which Miralax (polyethylene glycol) works, though through a different compound.

The advantage of magnesium citrate over Miralax is nutritional: the 20 to 30 percent of magnesium citrate that does absorb provides systemic magnesium. For someone eating 800 to 1,200 calories per day on Ozempic (compared to a typical 2,000+ calories before the medication), dietary magnesium intake drops proportionally. The recommended daily intake of magnesium is 310 to 420 mg depending on age and sex. At 800 calories per day, reaching even half of this through food alone is difficult.

Dosing for constipation: Start with 200 mg of elemental magnesium from magnesium citrate per day. If constipation persists after 3 to 5 days, increase to 400 mg. If 400 mg produces loose stool or diarrhea, reduce back to 200 mg. You have found your osmotic threshold. Take it with a full glass of water (the osmotic effect requires water to draw into the colon).

A 2026 systematic review in Cureus specifically evaluated the efficacy of magnesium supplementation in functional constipation and found evidence supporting magnesium as an effective intervention for improving stool frequency and consistency ( Kadhem et al., 2026). While this review examined functional constipation broadly rather than GLP-1-specific constipation, the osmotic mechanism is the same: unabsorbed magnesium in the gut draws water and softens stool regardless of the upstream cause of slow transit.

The American Gastroenterological Association's 2021 updated systematic review confirmed that osmotic laxatives (including magnesium-based products and polyethylene glycol) are effective and safe for chronic constipation, with PEG 3350 having the strongest evidence base among OTC options ( Rao et al., 2021). Magnesium citrate and PEG are both classified as osmotic laxatives and work through the same fundamental mechanism. The difference is that magnesium citrate provides the nutritional benefit of systemic magnesium absorption alongside the laxative effect, which PEG does not.

Timing: Taking magnesium citrate before bed works well for many people, producing a bowel movement the following morning. Taking it with breakfast is an alternative if morning dosing better fits your routine. Avoid taking it within 2 hours of your Ozempic injection or any other medication, as the laxative effect could theoretically reduce absorption of co-administered medications.

Why Magnesium Glycinate Does Not Help Constipation (and When to Use It Instead)

Magnesium glycinate is chelated, bonded to the amino acid glycine, which lets it absorb through amino acid transport pathways in the small intestine. Almost all of the magnesium enters the bloodstream, leaving virtually none in the gut lumen. No unabsorbed magnesium in the gut means no osmotic effect, which means no laxative action. Taking magnesium glycinate for constipation is one of the most common supplement mistakes.

Magnesium glycinate does have a role for Ozempic users, but it is a different role: it addresses the systemic effects of magnesium deficiency: sleep quality, muscle cramps, anxiety, and stress tolerance. If you are experiencing poor sleep, muscle cramps, or heightened anxiety on your GLP-1 medication, magnesium glycinate is the correct form. If your primary complaint is constipation, magnesium citrate is the correct form.

Some GLP-1 users benefit from both forms: magnesium citrate in the morning for bowel regularity, and magnesium glycinate in the evening for sleep. The total elemental magnesium from both sources should stay within 400 to 600 mg per day unless directed otherwise by a physician. Track your total across both forms to avoid exceeding this range.

Magnesium Form Comparison for GLP-1 Users: Citrate vs Oxide vs Glycinate

For GLP-1 users dealing with constipation, the choice between magnesium forms is not about quality. It is about mechanism. Citrate and oxide both provide osmotic laxative effects. Glycinate provides systemic magnesium without any laxative action. Understanding which form does what prevents you from taking the wrong one for your specific complaint.

For most Ozempic users with constipation, magnesium citrate at 200 to 400 mg elemental magnesium per day is the optimal starting choice. It provides a meaningful laxative effect while also delivering systemic magnesium. If citrate alone does not resolve constipation, magnesium oxide (400 to 800 mg) provides a stronger osmotic effect but contributes almost nothing to systemic magnesium levels, so you may need glycinate as a separate supplement to cover your systemic magnesium needs if you rely on oxide for bowel regularity.

A common and effective approach for GLP-1 users is to take magnesium citrate in the morning for bowel regularity, and magnesium glycinate in the evening for sleep quality and muscle recovery. The total elemental magnesium from both sources should remain within 400 to 600 mg per day for most adults. If you are unsure about your current magnesium status, a serum magnesium test is inexpensive and widely available. Levels below 1.8 mg/dL indicate clinical deficiency; many practitioners target 2.0 mg/dL or above as optimal.

Fiber: Essential but Must Be Introduced Carefully on a GLP-1

Fiber supplementation can help Ozempic constipation, but aggressive fiber loading on a stomach that empties 30 to 40 percent slower creates a predictable problem: nausea, bloating, and cramping that may be worse than the constipation itself. A 2026 systematic review and network meta-analysis confirmed that dietary fiber interventions improve constipation symptoms, with psyllium showing the strongest evidence among fiber types ( Mou et al., 2026).

The key is gradual introduction. Start with 5 grams of soluble fiber per day (roughly one tablespoon of psyllium husk in water) and increase by 5 grams every 3 to 5 days until you reach 20 to 25 grams per day or until nausea prevents further increases. Soluble fiber (psyllium, oats, chia seeds) is better tolerated than insoluble fiber (wheat bran, raw vegetables) on a GLP-1 because it forms a gel that moves through the GI tract more gently.

Every gram of fiber you consume requires additional water to form the bulk that stimulates peristalsis. Taking fiber without adequate water on a GLP-1 medication, where you are already likely under-hydrated, can actually worsen constipation by creating a drier, bulkier mass that your slowed colon cannot move efficiently. The rule: every fiber serving gets its own full glass of water, minimum.

Hydration Strategy: Why You Need to Drink More Than You Think

Semaglutide reduces not just appetite but also thirst perception. Many GLP-1 users report simply forgetting to drink water because the thirst signal is dampened alongside the hunger signal. Combined with reduced food intake (which normally provides 20 to 30 percent of daily water intake), total fluid consumption drops substantially. Dehydration concentrates stool and worsens constipation regardless of other interventions.

The practical target: aim for 2.5 to 3 liters (roughly 80 to 100 ounces) of total fluid per day. This sounds like a lot, but remember that your food-based fluid intake has dropped dramatically. Set a timer or use a water tracking app if needed, because relying on thirst will under-deliver while on a GLP-1 medication.

Electrolyte balance matters too. When you eat less, you consume less sodium, potassium, and magnesium, all of which influence fluid balance and intestinal motility. An electrolyte supplement or adding a pinch of salt to your water can help maintain the mineral balance that supports healthy bowel function. This is one reason why creatine hydration formulas that include electrolytes have become popular among GLP-1 users.

Other Interventions: Probiotics, Movement, and OTC Options

Beyond magnesium and fiber, several additional interventions can help manage Ozempic constipation. Physical movement (even walking) stimulates colonic motility. Probiotics may address the gut microbiome changes that GLP-1 medications cause. And when natural approaches are insufficient, over-the-counter osmotic laxatives like polyethylene glycol (Miralax) are safe for regular use.

Physical movement: A 15 to 30 minute walk after meals stimulates the gastrocolic reflex, the neural pathway that triggers colonic contractions when food enters the stomach. On a GLP-1 medication where this reflex is dampened, deliberate post-meal walking can partially compensate. This is the simplest, zero-cost intervention for mild constipation and has the added benefit of supporting the muscle preservation that matters during GLP-1-assisted weight loss.

Probiotics: GLP-1 medications alter the gut microbiome by changing the nutrient environment in the intestines. Reduced food volume and slowed transit create different conditions for bacterial growth. Some evidence suggests that Lactobacillus and Bifidobacterium strains can improve bowel regularity. While the evidence specifically for GLP-1-induced constipation is preliminary, probiotics are safe and may address the broader digestive changes that contribute to irregular bowel habits on semaglutide.

Polyethylene glycol (Miralax): If magnesium citrate alone is insufficient, adding or switching to PEG 3350 (Miralax) is a reasonable step. It works through the same osmotic mechanism as magnesium citrate but has no nutritional magnesium component. Many GLP-1 users find that alternating between magnesium citrate (for the nutritional benefit) and Miralax (for a stronger osmotic effect when needed) provides flexible constipation management.

A strain-specific 2026 systematic review and meta-analysis in the Journal of Clinical Medicine confirmed that specific Lactobacillus and Bifidobacterium strains improve bowel movement frequency and stool consistency in patients with constipation-predominant irritable bowel syndrome and functional constipation ( Maslennikov et al., 2026). While this review did not specifically evaluate GLP-1-induced constipation, the gut microbiome alterations caused by reduced food intake and slowed transit on semaglutide create conditions that overlap with functional constipation pathophysiology.

A 2026 dietary management review further supported the role of probiotics and prebiotic fiber in managing functional constipation through the gut-brain interaction framework ( Quan et al., 2026). For GLP-1 users, this is relevant because semaglutide directly affects the gut-brain axis, the same neural pathway that probiotics modulate. Adding a targeted probiotic to a constipation management protocol addresses a mechanism that magnesium and fiber do not.

Stimulant laxatives (senna, bisacodyl): These work by directly stimulating colonic nerve endings to produce contractions. They are effective for acute constipation but are not recommended for daily use because chronic stimulant laxative use can lead to dependence, as the colon becomes less responsive to normal peristaltic signals. Reserve stimulant laxatives for occasional use when osmotic approaches are insufficient, not as your daily strategy.

The Broader GLP-1 Nutrition Picture: Constipation Is Part of a Larger Pattern

Constipation on Ozempic is not an isolated symptom. It is one manifestation of a broader nutritional challenge: you are eating dramatically less food, which means dramatically less fiber, water, magnesium, protein, iron, B12, calcium, and vitamin D. Addressing constipation in isolation while ignoring the full nutritional picture is treating the symptom of a symptom.

The caloric deficit that makes GLP-1 medications effective for weight loss simultaneously creates a nutrient deficit. A person eating 900 to 1,200 calories per day, common on Ozempic at higher doses, is consuming roughly 40 to 50 percent of what they ate before. Their nutrient intake drops proportionally, but their nutrient requirements stay the same (or increase, given the metabolic stress of rapid weight loss).

For a comprehensive guide to the full nutritional strategy on GLP-1 medications, covering muscle preservation, hair protection, energy, and micronutrient adequacy as well as constipation, see our GLP-1 nutrition checklist. Muscle loss prevention and fatigue management are the other two pillars that most GLP-1 users need to address alongside constipation.

Foods That Help Ozempic Constipation: What to Eat When You Cannot Eat Much

When your total food intake drops to 800 to 1,200 calories per day, every food choice needs to serve double duty: nutritional density AND digestive function. The foods that most directly counter GLP-1-induced constipation are those that provide soluble fiber, water content, and magnesium in a form that is gentle on a sensitive, slow-moving stomach.

High-priority foods for constipation relief:

Prunes and prune juice deserve their reputation. They contain sorbitol, a sugar alcohol with natural osmotic laxative properties, plus fiber and polyphenols that stimulate colonic motility. Three to five prunes (or 120 mL of prune juice) daily is a clinically tested dose for constipation. They are calorie-dense relative to their volume, which can be an advantage or disadvantage depending on your caloric constraints.

Kiwifruit has emerged as one of the most evidence-supported foods for constipation. Two green kiwifruits per day significantly improved bowel movement frequency and stool consistency in multiple clinical trials. The mechanism involves a combination of fiber, actinidin (a proteolytic enzyme that improves gastric emptying), and water-holding capacity. For GLP-1 users, kiwifruits are particularly useful because they provide both fiber and an enzyme that partially compensates for slowed gastric motility.

Chia seeds expand to roughly 10 times their volume in water, forming a gel that adds bulk and water to the intestinal contents simultaneously. Two tablespoons of chia seeds soaked in water or added to a smoothie provides approximately 10 grams of fiber, significant omega-3 fatty acids, and a water-retaining matrix that moves gently through the GI tract. The key is pre-soaking: swallowing dry chia seeds on a slowed GI tract can worsen symptoms.

Oatmeal provides soluble fiber (beta-glucan) in a form that is extremely gentle on nauseous stomachs. Half a cup of dry oats cooked with water provides approximately 4 grams of fiber and is one of the most tolerable breakfast options for GLP-1 users experiencing both nausea and constipation. Adding a tablespoon of ground flaxseed increases the fiber to approximately 6 grams while also providing lignans and omega-3s.

Leafy greens (spinach, kale, Swiss chard) provide magnesium directly from food. One cup of cooked spinach contains approximately 157 mg of magnesium, nearly half the daily requirement. Cooking softens the fiber and reduces the volume, making it easier to consume on a suppressed appetite. A daily green smoothie (spinach, banana, chia seeds, water) can deliver fiber, magnesium, potassium, and water in a single easily-tolerated serving.

Foods to limit during active constipation:

Cheese, processed meats, white bread, and fried foods are all low in fiber and high in fat, a combination that slows an already-slow GI tract further. Bananas are sometimes recommended for potassium but unripe bananas are actually constipating due to their resistant starch content. Stick to ripe bananas, and pair them with a fiber source. Red meat is harder to digest and takes longer to transit through the colon, which is counterproductive when transit is already delayed.

The practical challenge on a GLP-1 medication is that appetite suppression makes it difficult to eat enough of anything. Prioritize the highest-fiber, highest-magnesium, highest-water-content foods first when you can eat, and fill remaining calories with lean protein (critical for muscle preservation) rather than constipation-promoting refined carbohydrates.

Constipation, Dehydration, and the Caloric Deficit: Why They Compound Each Other

On a GLP-1 medication, constipation rarely exists in isolation. Reduced food intake means less fiber, less water from food, fewer electrolytes, and less overall digestive stimulation. Dehydration concentrates stool. Low fiber reduces bulk. Slowed motility holds everything in place longer. These factors compound each other, and addressing only one while ignoring the others produces incomplete results.

Think of it as a system with four inputs: motility (controlled by the medication), water (controlled by your drinking habits), fiber (controlled by your diet), and electrolytes (controlled by your mineral intake). The medication locks the motility input at a reduced level. To compensate, you need to optimize the other three: more deliberate water intake, more deliberate fiber intake, and more deliberate mineral supplementation, particularly magnesium, sodium, and potassium.

This is why the most successful constipation management strategies for GLP-1 users are multi-pronged. Magnesium citrate alone helps. Fiber alone helps somewhat. Water alone helps somewhat. But the full combination, magnesium citrate for osmotic effect, psyllium for bulk, and 2.5 to 3 liters of water daily, reliably resolves constipation for the majority of GLP-1 users without requiring pharmaceutical laxatives.

The mineral-depletion concern extends beyond magnesium. Potassium, sodium, iron, B12, calcium, and vitamin D all drop proportionally with caloric intake. For a full protocol addressing the complete nutritional picture beyond constipation, see our guide to what to take when you cannot eat enough on a GLP-1. The hair loss that many GLP-1 users experience is another downstream consequence of this same caloric-restriction-driven nutritional deficit, and fatigue is yet another.

Ozempic Constipation Timeline: What to Expect at Each Stage

Understanding the typical progression of Ozempic constipation helps you prepare interventions before symptoms become severe, rather than reacting after the fact. The constipation pattern follows the dose-escalation schedule, with predictable windows of worsening and potential improvement.

Weeks 1 through 4 (0.25 mg dose): Constipation is mild or absent at the starting dose for most patients. GI side effects at this stage are more commonly nausea-related. This is the ideal window to establish your baseline habits: begin tracking daily water intake (targeting 2.5 to 3 liters), introduce psyllium husk fiber gradually, and start magnesium citrate at 200 mg per day as a preventive measure. Proactive management at this stage prevents the compounding effect of dehydration and low fiber before the dose increases.

Weeks 5 through 8 (0.5 mg dose): The first dose increase is when most patients first notice constipation. Gastric emptying slows noticeably, and the transition period can bring a combination of nausea, reduced appetite, and irregular bowel movements. If you established the Level 1 and Level 2 interventions above during the 0.25 mg phase, constipation is typically manageable. If you waited, this is the catch-up point where you need to implement water, magnesium citrate, and fiber simultaneously.

Weeks 9 through 16 (1.0 mg dose or Wegovy 1.7 to 2.4 mg): Constipation reaches its maximum severity for most patients during the higher-dose phases. The 47-day median duration of semaglutide constipation roughly aligns with this dose-escalation window. If your constipation is not adequately controlled by magnesium citrate and fiber at this point, adding polyethylene glycol (Miralax) is appropriate.

Months 4+ (maintenance dose): Many patients report that constipation moderately improves after several months at a stable dose, as the GI tract partially adapts to the reduced motility. However, the improvement is often incomplete. Most patients who experience constipation at higher doses continue to need at least some form of osmotic support (magnesium citrate or Miralax) throughout their course of treatment. The nutritional interventions (water, fiber, magnesium) should be considered permanent additions to your daily routine for as long as you continue the GLP-1 medication.

After discontinuation: If you stop taking Ozempic or Wegovy, bowel function typically normalizes within 2 to 4 weeks as semaglutide's extended half-life (approximately 7 days) allows the medication to gradually clear from your system. You can taper magnesium citrate and fiber accordingly, but many people choose to continue magnesium supplementation for its systemic benefits, particularly magnesium glycinate for sleep quality, even after the constipation indication resolves.

A Practical Ozempic Constipation Protocol

This evidence-based protocol layers interventions from simplest to most aggressive, allowing you to find the minimum effective approach for your specific situation.

Level 1 (start here): Increase water intake to 2.5 to 3 liters per day. Walk 15 to 30 minutes after your largest meal. These two changes alone resolve mild constipation in many GLP-1 users at no cost.

Level 2 (add if Level 1 is insufficient after one week): Add magnesium citrate 200 to 400 mg elemental magnesium per day, taken with a full glass of water. Add 5 to 10 grams of psyllium husk fiber, increasing gradually.

Level 3 (add if Levels 1 and 2 are insufficient after two more weeks): Add polyethylene glycol (Miralax) 17 grams in 8 ounces of water once daily. Consider a probiotic with Lactobacillus and Bifidobacterium strains.

Level 4 (consult your physician): If constipation persists despite Levels 1 through 3 for more than 4 weeks, discuss with your prescribing physician. Options include dose adjustment, temporary addition of a prescription prokinetic, or evaluation for an underlying GI condition that the constipation may be masking.

When to seek urgent care: No bowel movement for 7 or more days, severe abdominal pain, vomiting, blood in stool, or inability to pass gas. These may indicate a bowel obstruction, which is a medical emergency that is rare but reported with GLP-1 medications.

If you are taking a GLP-1 companion supplement, check whether it already includes magnesium. Many formulated GLP-1 companion products contain magnesium in some form, but the amount and type vary significantly. Some include magnesium oxide (which provides an osmotic laxative effect, good for constipation) while others include magnesium glycinate (which absorbs well but does not address constipation). Read the label, identify the form, and supplement accordingly to fill whatever gap remains.

Creatine hydration formulas deserve mention in this context as well. Our creatine hydration powder includes electrolytes that support the hydration status critical for bowel regularity. Creatine itself draws water into muscle tissue (intracellular hydration), which is metabolically beneficial but means you need additional water beyond what creatine retains. If you take creatine on a GLP-1 medication, increase your daily water target by an additional 500 mL to account for this.

When to Talk to Your Doctor About Changing Your GLP-1 Medication

If constipation significantly impacts your quality of life despite implementing Levels 1 through 3 of the protocol above for at least 6 weeks, discussing medication options with your prescriber is appropriate. Some patients tolerate tirzepatide (Mounjaro, Zepbound) better than semaglutide for GI side effects, though individual responses vary.

The data on comparative GI tolerability between GLP-1 medications is mixed. Clinical trial rates for constipation are 5 to 6 percent for both semaglutide and tirzepatide at comparable weight-loss doses, suggesting similar overall risk. However, individual variation is significant, and some patients who cannot tolerate one GLP-1 do well on another, and the only way to know is to try under medical supervision.

Constipation alone is rarely a reason to discontinue GLP-1 therapy entirely, given the substantial metabolic benefits of these medications. But persistent, severe constipation that does not respond to multiple interventions does warrant a conversation about whether the current medication and dose are the right fit for you specifically.

What is the best magnesium for Ozempic constipation?

Magnesium citrate. It works as an osmotic laxative (drawing water into the colon) while also providing absorbable magnesium to offset the reduced intake from eating less. Start at 200 mg elemental magnesium per day and increase to 400 mg if needed. Magnesium glycinate does not help constipation, because it absorbs too well to produce a laxative effect.

How long does Ozempic constipation last?

Data shows constipation on semaglutide lasts a median of 47 days, making it one of the longer-lasting GI side effects. It often worsens during dose escalation and may persist throughout treatment. Proactive management with magnesium citrate, fiber, and adequate hydration can significantly reduce severity and duration.

Does fiber help with Ozempic constipation?

Yes, but it must be introduced gradually. Start with 5 grams of soluble fiber (psyllium husk) per day and increase by 5 grams every 3 to 5 days. Too much fiber too fast on a slowed GI tract will worsen nausea and bloating. Always take fiber with a full glass of water.

Can I take Miralax with Ozempic?

Yes. Polyethylene glycol (Miralax) is an osmotic laxative that is safe for daily use and does not interact with semaglutide. It can be used alongside or instead of magnesium citrate. Many GLP-1 users alternate between the two depending on daily symptom severity.

Should I take probiotics on Ozempic?

Probiotics may help GLP-1-induced constipation by addressing the gut microbiome changes that reduced food intake and slowed transit cause. The evidence is preliminary but promising. Choose a multi-strain product with at least 10 billion CFU and allow 8 weeks for assessment.

When should I see a doctor about Ozempic constipation?

See a doctor if you have had no bowel movement for 7 or more days, have severe abdominal pain, are vomiting, notice blood in your stool, or cannot pass gas. These may indicate a bowel obstruction. Also consult your physician if constipation persists despite 6 weeks of implementing water, magnesium citrate, fiber, and osmotic laxatives.