When you take colesevelam, a bile acid sequestrant used to lower LDL cholesterol. Also known as Welchol, it works by binding to bile acids in your gut and forcing your liver to pull more cholesterol from your blood. But for many people, that same mechanism causes a side effect no one talks about enough: constipation. It’s not rare—up to 1 in 5 users report it, and for some, it’s severe enough to stop taking the drug.
This isn’t just about being uncomfortable. bile acid sequestrants, a class of drugs that trap bile in the intestines like colesevelam, cholestyramine, and colestipol all work the same way: they add bulk to stool and slow digestion. That’s great for cholesterol—but bad for bowel movements. If you’re already prone to slow digestion, taking low-fiber meals, or on other meds like opioids or anticholinergics, your risk goes up. Even people who eat well can get stuck because colesevelam absorbs water in the gut, drying out stool. It’s not a reaction to an allergy—it’s a mechanical side effect.
Many assume constipation from cholesterol meds is normal and just live with it. But it doesn’t have to be. Simple fixes like drinking more water (at least 8 cups a day), adding soluble fiber like oats or psyllium, and moving more can make a big difference. Avoiding low-fiber snacks and processed foods helps too. If you’re on other meds, talk to your pharmacist—some combinations make constipation worse. And if you’re using laxatives long-term, that’s a red flag. Your body shouldn’t need them just to function because of a cholesterol pill.
What’s surprising is how often this side effect gets missed in doctor visits. Patients don’t mention it because they think it’s expected. Doctors don’t ask because they focus on cholesterol numbers. But if you’re skipping doses or quitting colesevelam because of constipation, you’re risking your heart health. The good news? There are alternatives. Other cholesterol-lowering drugs like ezetimibe or statins don’t cause this issue the same way. And if you stick with colesevelam, adjusting the dose or timing—like taking it with meals instead of on an empty stomach—can help.
Below, you’ll find real patient experiences, expert advice on managing gut side effects from meds, and how to tell if your constipation is just a side effect or something more serious. You’ll also see how other drugs—like tricyclic antidepressants or anticholinergics—can make this worse, and what to do if you’re on multiple pills. This isn’t just about colesevelam. It’s about understanding how your whole medication list affects your body, and how to stay in control of your health without sacrificing one for the other.
Colesevelam helps manage diabetes and cholesterol but commonly causes constipation and bloating. Learn how to prevent and manage these side effects with dose titration, hydration, fiber, and safe laxatives - backed by clinical data and patient experiences.