Still Constipated? Why Linzess Works + Medically Approved Next Steps

Constipation can be frustrating, uncomfortable, and sometimes painful. If you've tried fiber, water, exercise, and over‑the‑counter laxatives without success, your doctor may have prescribed Linzess (linaclotide).

But what if you're still constipated — or wondering how Linzess actually works?

Here's what you need to know, based on trusted medical research and clinical guidelines.

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What Is Linzess?

Linzess (linaclotide) is a prescription medication approved for:

• Chronic idiopathic constipation (CIC) – ongoing constipation without a known cause
• Irritable bowel syndrome with constipation (IBS‑C)
• Functional constipation in certain pediatric patients (as approved by a physician)

Unlike stimulant laxatives, Linzess works directly on the lining of your intestines. It is not absorbed into the bloodstream in meaningful amounts, which means its effects are largely local to the gut.

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How Linzess Works (In Simple Terms)

Linzess activates something called guanylate cyclase‑C (GC‑C) receptors on the surface of your intestinal lining.

That activation:

• Increases fluid secretion into the intestines
• Speeds up the movement of stool through the colon
• Helps soften stool
• Reduces abdominal pain in IBS‑C

The added fluid makes bowel movements easier to pass, while the improved motility helps your body move waste more normally.

Many people notice:

• More frequent bowel movements
• Softer stools
• Less straining
• Less bloating
• Reduced abdominal discomfort (especially in IBS‑C)

It's typically taken once daily on an empty stomach, at least 30 minutes before the first meal.

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How Long Does Linzess Take to Work?

Some people see results within the first few days. For others, it may take 1–2 weeks to notice consistent improvement.

Doctors usually recommend giving it several weeks before deciding whether it's effective. If you stop too early, you may not see its full benefit.

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Why You Might Still Be Constipated on Linzess

If you're still struggling, there are several possible reasons.

1. Dose May Need Adjustment

Linzess comes in different doses depending on the condition:

• Lower doses for chronic constipation
• Higher doses for IBS‑C

If symptoms persist, your doctor may reassess your dose.

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2. You May Not Be Taking It Correctly

For best results:

• Take it on an empty stomach
• Wait at least 30 minutes before eating
• Take it at the same time each day

Taking it with food can increase diarrhea risk or reduce predictable effectiveness.

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3. Dehydration or Low Fiber Intake

Even though Linzess increases intestinal fluid, your body still needs adequate hydration.

Make sure you are:

• Drinking enough water (unless medically restricted)
• Getting appropriate fiber (but not overdoing it)

Too little fiber can worsen constipation. Too much fiber without fluid can make it worse as well.

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4. Pelvic Floor Dysfunction

Some people have difficulty relaxing the muscles needed to pass stool. This is called dyssynergic defecation.

In these cases:

• Linzess may soften stool
• But muscle coordination issues prevent effective bowel movements

Pelvic floor physical therapy or biofeedback may be recommended.

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5. Underlying Medical Conditions

Persistent constipation can sometimes signal:

• Thyroid disorders
• Diabetes
• Neurological conditions
• Medication side effects (opioids, antidepressants, iron, etc.)
• Colon structural problems

If symptoms are new, worsening, or accompanied by warning signs (see below), further evaluation is important.

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Common Side Effects of Linzess

The most common side effect is diarrhea. For most people, it's mild to moderate.

Other possible side effects include:

• Gas
• Abdominal discomfort
• Bloating

Severe diarrhea is uncommon but possible. If you experience dehydration symptoms (dizziness, weakness, reduced urination), contact your doctor.

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When Constipation Could Be Serious

While constipation is usually not dangerous, seek medical care urgently if you have:

• Blood in your stool
• Black, tarry stools
• Unexplained weight loss
• Severe abdominal pain
• Vomiting
• Sudden change in bowel habits after age 50
• Family history of colon cancer with new symptoms

These symptoms require prompt evaluation.

If you're experiencing ongoing symptoms and want personalized guidance on what might be causing them, try Ubie's free AI-powered Constipation Symptom Checker to get clinically-backed insights in just a few minutes.

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Medically Approved Next Steps If Linzess Isn't Enough

If Linzess alone isn't solving the issue, your doctor may consider the following evidence‑based options:

1. Reassess Diagnosis

Is it:

• Chronic idiopathic constipation?
• IBS‑C?
• Medication‑induced constipation?
• Pelvic floor dysfunction?

Clarifying the root cause guides better treatment.

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2. Adjust the Treatment Plan

Your provider may recommend:

• Dose modification
• Switching to another prescription medication (such as other secretagogues or pro‑motility agents)
• Adding osmotic laxatives (like polyethylene glycol)
• Short‑term stimulant laxatives under supervision

Combination therapy is sometimes appropriate.

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3. Evaluate Diet & Lifestyle

Medical guidelines still emphasize:

• Gradual fiber increase (if tolerated)
• Adequate hydration
• Regular physical activity
• Consistent bathroom timing (especially after meals)

The gastrocolic reflex — your body's natural urge to move bowels after eating — is stronger in the morning. Taking advantage of this can help.

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4. Pelvic Floor Therapy

If muscle coordination is the problem, biofeedback therapy can be highly effective and is supported by clinical research.

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5. Diagnostic Testing (If Needed)

If symptoms are persistent or atypical, doctors may consider:

• Blood tests
• Thyroid testing
• Colonoscopy (especially over age 45–50 or with red flags)
• Colonic transit studies

These are not needed for everyone — only when clinically appropriate.

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What Linzess Does Not Do

It's important to be realistic:

• Linzess does not cure constipation permanently
• It works while you take it
• Stopping it often leads to return of symptoms

Chronic constipation is often a long‑term condition requiring ongoing management.

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When to Speak to a Doctor

Always speak to a healthcare provider if:

• Linzess isn't working after several weeks
• Side effects are severe
• Symptoms are worsening
• You have any red‑flag symptoms

Constipation is common — but persistent constipation deserves proper medical evaluation.

If anything feels severe, sudden, or life‑threatening, seek immediate medical care.

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The Bottom Line

Linzess works by increasing intestinal fluid and improving stool movement through the colon. For many people with chronic constipation or IBS‑C, it significantly improves bowel frequency and reduces discomfort.

But if you're still constipated:

• The dose may need adjusting
• The diagnosis may need clarification
• A combination approach may work better
• Pelvic floor issues could be involved
• Another medical condition may need to be ruled out

Constipation can be uncomfortable — but it is manageable. With the right evaluation and treatment plan, most people can find relief.

If you're unsure what's causing your symptoms, consider completing a free online symptom check for Constipation and then speak to a doctor about the results.

Persistent bowel changes are not something to ignore — but they are very often treatable with the right plan.