DEAR DR. ROACH: I have dealt with irritable bowel syndrome for over 40 years. However, now over the past few years I have had mild constipation and very frequent bloating. I take dicyclomine, 10 mg, before meals and bedtime, that helps a little with spasms. When bloating is more constant, I take Phazyme, Tums and Pepto-Bismol, along with 150-mg ranitidine, which helps a little. I am concerned that I am taking too many types of pills to control it.

My question is if it is OK to take all of these pills within a couple of hours, or is there a better alternative? I wore a heart monitor for a month because of irregular heartbeats and heavy heart beat. I feel the problem was caused by the pressure of bloating. — J.F.

ANSWER: Irritable bowel syndrome is a disorder of the gastrointestinal tract, manifested by abdominal pain or discomfort, along with changes in bowel movements, such as diarrhea or constipation.

Primary treatment for IBS is an appropriate diet and relationship with food. It is possible other dietary changes may reduce the need for medication, and a meeting with a gastroenterologist and a nutritionist dietician may be have a dramatic effect on your symptoms.

I agree with you that you may not need all these medications.

However, I don’t think any of the drugs you are taking are likely to cause problems with your heartbeat.