What bottoms need to know about using Ozempic, according to medical professionals

How Ozempic and similar drugs work — and what that means for your digestion

In a nutshell, Ozempic and similar drugs promote weight loss by making you less hungry. In more technical terms, it is known as a GLP-1 receptor agonist, which means “It mimics the hormone GLP-1, which stimulates insulin release, reduces glucagon, and slows gastric emptying, which means food leaves your stomach more slowly,” Dr. Shuxiao tells PRIDE. “This means you feel full longer and have a reduced appetite.”

While your hunger is reduced, it can also lead to a handful of side effects, including nausea, vomiting, diarrhea, constipation, and bloating. But more importantly for bottoms, Dr. Shuxiao says it “will adjust the entire rhythm of your digestive tract to be slower, and thus can lead to irregular bowel habits.”

Even the most seasoned bottom may find that the consistency and frequency of their stool can change while on Ozempic. “[It] may become firmer and harder to pass for some, while for others it may lead to softer and more frequent stools,” says Dr. Shuxiao. “These effects are the most significant when the dose is started or adjusted and will improve over time as the body adjusts.”

What that means for bottoms. 

If you thought bottoms had their work cut out for themselves already, Ozempic can add layers of complexity in the bedroom because it can cause unpredictability in digestion.

“It may be harder to ensure the rectum is empty and comfortable during sex due to the unpredictable nature of bowel movements during this time,” Dr. Shuxiao warns, adding, “there may also be increased flatulence and bloating that may make both parties feel uncomfortable and can lead to embarrassing accidents or leakage during anal sex,” too.

While Dr. Shuxiao has not conducted a study on the subject, he cites anecdotal accounts, in which “uncontrollable diarrhea and constant feeling of not being 100% clean is common for individuals on Ozempic who engage in anal play.”

To help combat some of these effects, Bustamante highlights the even greater importance of a high-fiber diet for bottoms. “[It’s] key in order to make the ‘cleaning out’ process minimal and simple. But when patients are on Ozempic, they will need to account for even more fiber as digestion is naturally slower,” he says.

There is also an increased chance of anal fissures, warns Dr. Shuxiao. “The skin around the anal area may also be much more tender or irritated compared to normal,” due to going to the bathroom more frequently or constipation, which are a common cause of anal fissures and are exacerbated during anal sex. All of which means taking safe-sex precautions, like keeping up with your PrEP and DoxyPEP and condom use, is even more essential for tending to your sexual health and well-being.

So how should bottoms using Ozempic be prep for the bedroom? 

As always, diet is a big factor in being ready to bottom—more fiber intake, as Bustamante suggested, but also, Dr. Shuxiao recommends probiotic supplements to help ensure more even stool consistency.”

Also, douching, says Dr. Shuxiao, can help bottoms feel more confident that they are ready to go when the time comes. “They should also perform a brief anal rinse before sex to feel confident and clean. The medication may leave stool softer or stickier than normal, so even if they used a regular enema before, they may need to use an enema more frequently than before to maintain a similar level of cleanliness,” he explains.

Can fat loss or other effects of these drugs impact anal anatomy?

While changes and unpredictability of digestion are the biggest impacts on bottoming while on a GLP-1 drug, Dr. Shuxiao does point out that “Ozempic butt” exists, "which is a sagging or deflated appearance of the behind due to rapid weight loss.” Fortunately, it’s more of an aesthetic issue, which “will not directly harm your anal sphincter or an individual's ability to have anal sex,” assures Dr. Shuxiao.

One thing to consider, however, is that while on Ozempic and similar drugs, there is also the potential to rapidly lose muscle tissue, which Dr. Shuxiao warns may “impact the pelvic floor muscles and gluteal and core muscles, which may alter how tense the body can be during sex.” This is why both increased protein intake and weight training are often suggested while on GLP-1 drugs.

What other precautionary steps can you take, to help ensure your sex life thrives?

OK, that’s a lot, and who wants to give up the joys of bottoming? No one! Which is why the experts suggest the following tips:

• Keep hydrated to keep the gut motile and to prevent stool from being too hard or compacted.
  
• Practice pelvic floor exercises or pelvic floor relaxation techniques to optimize the muscles in that region.
  
• Use gentle wiping techniques or water rinses like a bidet to ensure anal skin is protected.
  
• Communication is key. Be upfront with your partner about your situation. Most people are aware of Ozempic’s reputation and will likely be understanding if you need extra time to prepare beforehand.
  
• Exercise in conjunction with a higher-fiber, high-protein diet to help keep digestion regular. When the body is regularly in motion, it aids digestion by regulating peristalsis, which is the pulsation of the intestines that keeps our bowels moving.
  
• High protein intake is critical to prevent muscle wasting, but you may want to avoid whey protein, as it’s dairy-based and may contribute to excess bloating.

• If you find yourself struggling with anal tightness or constipation (whether related to Ozempic or not), then consider HoleTox.

Ultimately, Ozempic and other GLP-1 drugs are relatively new, so we are still learning a lot about how they can be helpful and of their side effects. This is why it’s essential for bottoms to know the facts and make the choices that best suit them, both in and out of the bedroom.

Sources cited:

Dr. Austin Shuxiao, MD, owner a mobile IV therapy company in NYC

Chris Bustamante DNP, NP-C, owner & CEO of Lushful Aesthetics