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Barium Enema

What is a barium enema?

A barium enema is an imaging test that uses X-rays to look at your lower gastrointestinal (GI) tract. Your lower GI tract includes the large intestine (colon) and rectum.

X-rays use a small amount of radiation to create images of your bones and internal organs. X-rays are often used to detect bone or joint problems, or to check the heart and lungs. A barium enema is one type of X-ray.

Fluoroscopy is often used during a barium enema. Fluoroscopy is a kind of X-ray movie.

The test uses barium. Barium is a substance that makes certain areas of the body show up more clearly on an X-ray. The radiologist will be able to see the lining, size, and shape of the colon. These details might not be seen on a standard X-ray. Barium is used only for imaging tests for the GI tract.

After the barium is in your large intestine, the radiologist may fill the intestine with air. Air will look black on X-ray film. The barium will look white. This contrast makes smaller details show up. When barium and air are used together, the test is called a double contrast study.

Why might I need a barium enema?

A barium enema may be done to look for and diagnose problems in the colon and rectum. You may need a barium enema if your healthcare provider thinks that you may have:

  • Sores and inflammation in your colon (ulcerative colitis)
  • Sores and inflammation in other parts of your GI tract (Crohn's disease)
  • Blockage (obstruction) or growths (polyps)
  • Pouches in your colon (diverticula)
  • Cancer
  • Unusual bloating or pain in your lower abdomen
  • Unexplained weight loss
  • Irritable bowel syndrome
  • Changes in bowel movements, including chronic diarrhea or constipation, or passing of blood, mucus, or pus

Your healthcare provider may have other reasons to recommend a barium enema.

What are the risks of a barium enema?

You may want to ask your healthcare provider about the amount of radiation used during the test. Also ask about the risks as they apply to you.

Consider writing down all X-rays you get, including past scans and X-rays for other health reasons. Show this list to your provider. The risks of radiation exposure may be tied to the number of X-rays you have and the X-ray treatments you have over time.

Tell your provider if:

  • You are pregnant or think you may be. Radiation exposure during pregnancy may lead to birth defects.
  • You are allergic to or sensitive to medicines, contrast dyes, local anesthesia, iodine, or latex

Risks of barium enema may include:

  • Tear or hole in your colon (perforation)
  • Problems from the laxatives and enemas done before the test, such as dehydration or electrolyte changes
  • Very rarely, allergic or hypersensitivity reactions to the barium
  • Constipation or impacted stool if all of the barium does not pass out of your body

Certain things can make a barium enema less accurate. These include:

  • Recent barium swallow or upper GI tests
  • Colon spasm
  • Stool in the bowel

You should not have a barium enema if you have:

  • A tear or hole in your colon (bowel perforation)
  • Severe ulcerative colitis
  • Rapid colon distension (toxic megacolon)
  • Sudden abdominal pain

You should also not have this test if you are pregnant.

You may have other risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.

How do I get ready for a barium enema?

  • Your healthcare provider will explain the procedure to you. Ask him or her any questions you have.
  • You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
  • You will need to stop eating and drinking for about 8 hours before the test. Generally this means after midnight. You will be given bowel prep instructions to start on the day before the test. You may need to drink a laxative, use suppositories, or have an enema. You most likely will be on a clear liquid diet the day before, or maybe even a few days before the test. Clear liquids include clear broth, gelatin, tea, and clear soft drinks. This is done to get any solid stool out of your colon.
  • Tell your provider if you are pregnant or think you may be.
  • Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic drugs (local and general).
  • Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements. You may need to stop taking these before the test.
  • Tell your healthcare provider if you have had a recent barium swallow or upper GI test. This may make it harder to get good X-rays of the lower GI area.
  • Follow any other instructions your provider gives you to get ready.

What happens during a barium enema?

You may have a barium enema as an outpatient or as part of your stay in a hospital. The way the test is done may vary depending on your condition and your healthcare provider's practices.

Generally, a barium enema will follow this process:

  1. You'll be asked to remove any clothing, jewelry, or other objects that may get in the way of the procedure.
  2. You may be asked to remove clothing. If so, you will be given a gown to wear.
  3. The radiologist will take an X-ray to make sure your colon is clean.
  4. You will lie on your side on an exam table.
  5. The radiologist will put a soft, flexible rectal tube into your rectum. This will let the barium flow into your colon. A balloon near the end of the tube is inflated to keep the barium from leaking out.
  6. The barium will flow slowly into your colon. You may have cramping as the barium goes in. To lessen the discomfort, you can take slow deep breaths.
  7. You may feel the need to have a bowel movement. It will be important to resist this urge to keep the barium from leaking back out. Let the technologist know if you are having trouble. After the test, you will be given a bedpan or helped to the bathroom.
  8. During the test, the X-ray machine and exam table will move. You may be asked to move into different positions as the X-rays are taken.
  9. The radiologist will take single pictures, a series of X-rays, or fluoroscopy as the barium moves through your colon.
  10. When the procedure is done, the technologist will let the barium come out of the tube. He or she will deflate the balloon and remove the tube.
  11. If you are having a double contrast study, you will be asked to expel some of the barium. You will be given a bedpan or helped to a bathroom. Some barium will stay in your colon. The technologist will put air into your rectum to expand the colon. He or she will take more X-rays.
  12. Once all the X-rays have been taken, you will be helped from the table and to the bathroom, if needed.

What happens after a barium enema?

After the exam, some barium will be expelled right away. You will be helped to the bathroom or given a bedpan.

You may go back to your normal diet and activities after a barium enema, unless your healthcare provider tells you otherwise.

Barium may cause constipation or impacted stool after the procedure if it isn't completely cleared from your body. You may be told to drink plenty of fluids and eat foods high in fiber to help the rest of the barium leave your body. You may also be given a laxative to help with this.

Your bowel movements may be white or lighter in color until all the barium has left your body.

You may feel tired afterward because of the lengthy bowel preparation needed before the test. Rest as needed.

Your anus and rectum may be sore because of the bowel preparation. Your healthcare provider may recommend an ointment to soothe the area.

Call your healthcare provider right away if any of these occur:

  • Trouble with bowel movements or you are unable to have a bowel movement or pass gas
  • Rectal bleeding
  • Pain or swelling of the abdomen
  • Stools that are smaller in size than normal
  • Fever

Your healthcare provider may give you other instructions, depending on your situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would  happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

Medical Reviewers:

  • Dozier, Tennille, RN, BSN, RDMS
  • Lehrer, Jenifer MD