Slimming Success or Health Setback? Weight Loss Drugs + The Pelvic Floor
By Cambria Oetken, DPT, PHRC Westlake Village
What is Ozempic?
You may be familiar with the name “Ozempic,” “Semaglutide” or even “GLP-1” likely due to their social media presence and celebrity influencers, so what really are these drugs and what do they do in our bodies? Semaglutide has gained increased attention in the most recent years for its role in managing type 2 diabetes and aiding in weight loss. This GLP-1 receptor agonist (GLP-1 RA) has been a game-changer for many patients struggling with type 2 diabetes however, it is now playing a role in weight loss. You may have heard other hot names that are also “GLP-1 receptor agonists” such as Trulicity, Wegovy, Mounjaro, Bzetta, Bydureon and Adlyxin to name a few. The question is, are these medications safe and effective? What are the side effects? If I have pelvic floor dysfunction, can this negatively or positively affect it??
So what in the world is GLP-1?
Glucagon-like peptide 1 (GLP-1) receptor agonists belong to a class of type-2 diabetes medications that mimic the function of the GLP-1 hormone secreted by the pancreas. Overtime, if there is poor glucose control in the body, this enzyme becomes less effective at regulating glucose, this is when a synthetic GLP-1 receptor agonist comes into play. GLP-1 RA can suppress appetite, delay gastric emptying, reduce plasma glucose levels and enhance insulin secretion in order to regulate glucose levels.
Ozempic, Wegovy, Zepbound etc….
Ozempic is an injection that was approved in 2017 to help lower blood sugar levels and reduce the risk of heart attack, stroke, or death in adults with type 2 diabetes and known heart disease. This drug is not approved by the U.S Food and Drug Administration for weight management however there are some that are. Wegovy (semaglutide) injection is a well known drug that IS approved by the U.S Food and Drug Administration (2021) for chronic weight management in adults with obesity or are overweight. Other examples of drugs that are FDA approved for weight management include, Zepbound and Saxenda. There are some differences between the types of drugs and dosages. For example, the dosage for Wegovy can be up to 2.4 mg performed once weekly as an injection whereas Ozempic contains lower doses of semaglutide at around 0.25 mg once weekly to start increasing to up to 2.0 mg. The significant difference is that Ozempic is approved to address insulin resistance for those with Type 2 Diabetes and not for weight loss, whereas Wegovy is approved as a weight loss treatment for those who qualify. The issue that has arisen is Ozempic is increasingly being prescribed off-label for weight loss without an FDA approval on its safety and efficacy. Additional concerns, as reported by the FDA, include compounding multiple GLP1 receptor agonists together leading to serious side effects. Due to this increase in off label use, patients should be aware and educated on treatment options, the impacts of off-label prescribing, and the side effects of these medications. Always speak to a provider regarding these options.
Common side effects and how they may impact your pelvic floor:
The most common side effects of GLP-1 RA include gastrointestinal effects such as nausea, vomiting, diarrhea, and constipation however usually do not cause the need for discontinuation of the drug. Other side effects include itchiness, redness, or other reactions at the injection site, headache, dizziness, mild tachycardia (increased heart rate), and infections. Some serious side effects include pancreatitis, gastroparesis, bowel obstruction, gallstone attacks, and bile duct blockage, however these side effects are rare and have been difficult to confirm a cause and effect relationship.
Constipation and diarrhea as well as bowel incontinence can be indicators of pelvic floor dysfunction and thus these types of drugs could exacerbate these existing symptoms. One of the common side effects of Ozempic is gastrointestinal issues, including constipation. This can occur due to its effect on slowing gastric emptying. When the stomach empties more slowly, food and waste move more gradually through the digestive tract, which can lead to reduced bowel movements and thus constipation.
Managing Constipation While on Ozempic
If you’re experiencing constipation while taking Ozempic, there are several strategies you can use to manage and maybe even alleviate this side effect:
1. Increase Fiber Intake
- Eat More Fruits and Vegetables: Incorporate high-fiber fruits and vegetables into your diet. (1 cup of raspberries has 8 grams of fiber!)
- Whole Grains: Opt for whole grain bread, cereals, and pasta.
2. Stay Hydrated
- Drink Plenty of Water: Adequate hydration helps support regular bowel movements. Opt for up to half your body weight in ounces of water a day.
3. Regular Physical Activity
- Exercise: Engage in regular physical activity to stimulate bowel function and improve digestion. Even walking for just 10 minutes a day can be beneficial!
4. Consider Over-the-Counter Remedies
- Fiber Supplements: Products like psyllium husk can help increase your fiber intake.
5. Proper Positioning
- Squatty Potty: Using a squatty potty or stool to elevate your feet can help relax the pelvic floor muscles to increase ease with bowel movements.
6. See a Pelvic Floor Physical Therapist
- Muscle Coordination: A pelvic floor PT can help address motor control of the pelvic floor muscles to ensure you are properly utilizing your muscles effectively during bowel movements
- Manual Therapy: Manual therapy can be performed along the colon to assist is stool movement and reducing any discomfort
When to Seek Medical Advice
While mild constipation can often be managed with lifestyle and dietary changes, you should contact your healthcare provider if:
- Constipation Persists: If you experience severe or persistent constipation that doesn’t improve with home remedies.
- Severe Discomfort: If you have significant abdominal pain or discomfort.
- Changes in Bowel Habits: If you notice any unusual changes in your bowel habits or if you experience additional symptoms like nausea or vomiting.
There is a relevant study indicating an association between insulin levels and the activity of the pelvic floor muscles. In this study, the group with insulin resistance had lower activity of the pelvic floor muscles than those without insulin resistance. It is thought that skeletal muscles (such as those in the pelvic floor) can adapt to metabolic needs (such as insulin needs) in order to maintain energy balance and nutrient use, therefore decreasing activation of those muscles for energy conservation. There is also a known relationship between decreased muscle mass and short term use of glucose. Interestingly, for those struggling with Type 2 diabetes, insulin resistance and additional criteria could benefit from a GLP-1 receptor agonist and may have an added benefit of improved pelvic floor muscle activation.
An additional study looked at GLP-1 with the use of Metformin on the effect in men with Type 2 Diabetes and erectile dysfunction. Following 12 months of treatment, glucose management greatly improved than with Metformin alone, resulting in weight loss, improvement in blood glucose levels, increase in total and free testosterone levels and improvement in erectile dysfunction. The study concluded that there could be potential vasculature effects that occurred with the addition of GLP-1 RA.
To conclude, in patients who qualify for GLP-1 RA drugs, there could be both potential benefits in overall pelvic functioning but also potential increase in dysfunction if there is present pelvic floor dysfunction previously.
Practical Considerations
For individuals experiencing pelvic floor dysfunction who are also managing obesity or type 2 diabetes, semaglutide may offer a multifaceted approach to health improvement. However, it is crucial to approach treatment comprehensively:
- Consult Healthcare Providers: Always discuss any new medication or treatment approach with your healthcare provider, especially when dealing with complex conditions like pelvic floor dysfunction.
- Integrate a Holistic Approach: Alongside semaglutide, consider pelvic floor physical therapy, lifestyle modifications, and other treatments tailored to pelvic health.
- Monitor and Evaluate: Regularly assess how the medication is impacting both your weight and pelvic floor symptoms, and adjust treatment plans as needed.
Conclusion
Semaglutide has proven to be an effective tool for managing type 2 diabetes and aiding in weight loss. While direct evidence linking semaglutide to improvements in pelvic floor dysfunction is still emerging, the medication’s benefits in weight management and metabolic health may offer indirect advantages for individuals dealing with pelvic floor issues. As always, personal health decisions should be guided by a thorough discussion with healthcare professionals to ensure a comprehensive and effective approach to treatment.
Research
https://pubmed.ncbi.nlm.nih.gov/37615353/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559236/
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533252/)
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533252/).
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