Test Overview

A barium enema is an
X-ray exam of the
large intestine (colon and rectum). It may also be called a lower gastrointestinal (GI) exam. The test is used to help find diseases
and other problems that affect the large intestine. The colon is filled with a
contrast material that contains barium so that the intestine can be seen on an X-ray. This is done by
pouring the contrast material through a tube inserted into the anus. The barium
blocks X-rays. This causes the barium-filled colon to show up clearly on the X-ray
picture.

There are two types of barium enemas.

  • In a
    single-contrast study, the colon is filled with
    barium. This outlines the intestine and shows large
    abnormalities.
  • In a double-contrast or
    air-contrast study, the colon is first filled with
    barium, and then the barium is drained out. This leaves only a thin layer of barium
    on the wall of the colon. The colon is then filled with air. This provides a
    detailed view of the inner surface of the colon. It makes it easier to see
    narrowed areas (strictures),
    diverticula, and swelling.

The single-contrast study may be the better choice for certain medical reasons. It may also be a good choice for older people who may not be able to
tolerate a double-contrast study, which takes longer and is more uncomfortable. If the results are not clear, then a double-contrast study may also be
done.

Why It Is Done

A barium enema is done to:

  • Find swelling of the intestinal wall that occurs in
    inflammatory bowel diseases. Examples are
    ulcerative colitis and
    Crohn’s disease. A barium enema also may be used to
    keep track of the progress of these diseases.
  • Find problems with the
    structure of the large intestine. Problems may include narrowed areas (strictures) or
    pockets or sacs (diverticula) in the intestinal wall.
  • Help correct
    a condition called ileocolic
    intussusception. This occurs when the end of a child’s small
    intestine protrudes into the large intestine.
  • Check on belly
    symptoms such as pain, blood in stool, or altered bowel habits.
  • Check on other problems such as anemia or unexplained weight loss.

How To Prepare

Before a barium enema, tell your
doctor if you:

  • Are or might be pregnant.
  • Are
    allergic to latex. Latex products are often used to give the contrast
    material. If you have a latex allergy, different products will be
    used.
  • Know that you are allergic to barium.
  • Have had an
    upper digestive barium test (upper GI or barium swallow) recently.
  • Have had a colonoscopy or sigmoidoscopy recently.

Before a barium enema, you must prepare your large intestine so that it is very clean. The colon must be completely
clear of stool and gas. Even a small amount of stool can affect the results of
the test.

  • For 1 to 3 days before the test, you will most likely be on a
    clear liquid diet.
  • On the day before the
    test:

    • You should drink very large amounts of
      noncarbonated clear liquids, unless your doctor has advised you not
      to.
    • You will then take laxatives to empty your
      intestines.
    • You may be asked to take a tap water
      enema to clean any remaining stool from your
      colon.
  • On the day of the test, you may need to repeat
    the enema until the liquid that passes is free of any stool.
    Sometimes a
    rectal suppository or a store-bought enema,
    such as a Fleet enema, is used instead of a tap water enema.

Talk to your doctor about any concerns you have regarding
the need for this test. Ask about its risks, how it will be done, and what the results
will mean. To help you understand the importance of this test, fill out the
medical test information form (What is a PDF document?).

How It Is Done

During the test

The colon is filled with a contrast material that contains barium so that the colon can be seen on an X-ray.
This is done by pouring the contrast material through a tube inserted into the
anus. The barium blocks X-rays, causing the
barium-filled colon to show up clearly on the X-ray picture.

  • You will lie on the X-ray table while the first X-ray film is taken.
  • While you are
    lying on your side, a well-lubricated enema tube will be inserted gently into
    your rectum. The barium contrast material is then allowed to flow slowly into
    your colon.
  • A small balloon on the enema tip may be filled with air to
    help you hold in the barium. Tightening your anal sphincter muscle (as if you
    were trying to hold back a bowel movement) against the tube may help. Taking slow,
    deep breaths may also help.
  • You may be given a shot of medicine to relieve the cramping.

Your doctor will watch the flow of the barium through
your colon on an X-ray
fluoroscope monitor that is like a TV
screen.

  • You will be asked to turn to different
    positions (sides, front, and
    back). The table may be tilted slightly to help the barium flow through
    your colon and to take X-rays from different directions.
  • Your doctor may also press gently on your belly with his
    or her hand or a plastic paddle. This can help move the barium through your
    intestines.
  • If a double-contrast study is being done, the barium
    will be drained out and your colon will be filled with air.

A single-contrast study usually takes 30 to 45 minutes. But the actual time the barium is held inside is only 10 to 15 minutes. A
double- or air-contrast study may take up to an hour.

After the test

When the test is finished:

  • The enema tube is removed.
  • You will be given a bedpan or be taken to the toilet to get rid of
    as much of the barium as you can.
  • One or two more X-ray
    pictures (post-evacuation films) will then be taken.

After the
test, you may go back to your regular diet unless your doctor gives you other instructions. Be sure to
drink plenty of liquids. They replace those you have lost, and they help flush the
remaining barium out of your system. Your bowel movements may look white or
pinkish for 1 to 2 days after the test. Your doctor may tell you to take a medicine, such as a
laxative, to help you pass the rest of the barium.

How It Feels

A barium enema can be
uncomfortable and tiring. But it usually doesn’t last very long.

Many people report that the preparation and bowel cleaning are the hardest parts. The laxative may not taste good, and the
frequent bowel movements can be tiring. Also, the anal area can become quite
sore during the process. Warm
sitz baths or a local anesthetic salve, such as
Preparation H, can help ease this discomfort.

You may be
embarrassed by the test. You may worry that you won’t be able to hold the
barium and that it will leak onto you or onto the table. The doctors who
perform this procedure are used to this. They will be able to help
you.

The X-ray table is hard and sometimes cold because
air-conditioning is used to keep the equipment cool. When the barium first
flows into your colon, it may feel a bit cool. As your colon fills, you may
have a feeling of fullness, moderate cramping, and a strong urge to have a
bowel movement. If an air-contrast study is performed, you may feel more
cramping or gas pains from having gas pumped into your large intestine. Taking
slow, deep breaths through your mouth can help you relax.

The test may take awhile. You may want to bring something to do quietly (like bringing a book or magazine to read).

You may
feel tired for a day or so after the test. Make sure to arrange for someone to
drive you home after the test. This test can be exhausting.

Risks

There is very little chance of a problem from
having a barium enema.

  • Sometimes the barium that remains in the colon hardens. This can cause severe constipation (impaction) or obstruction. To decrease your risk, drink extra fluids after the test. If
    your doctor recommends it, use an enema or mild
    laxative after the test.
  • In rare cases,
    barium can cause swollen areas in the colon. These are called barium
    granulomas.
  • Perforation of the bowel is a more serious, but very
    rare, complication. Under the pressure from the barium or air, a weakened
    section of the colon may break open. This allows the contents of the intestine to spill
    into the abdominal cavity. It may occur in people whose bowel wall has been
    weakened by intestinal problems, such as inflammatory bowel diseases (ulcerative colitis or Crohn’s disease).

Call your doctor right away if you:

  • Have rectal bleeding.
  • Have severe
    belly pain.
  • Get a fever.
  • Do not have a bowel
    movement within several days after the test.

Results

A barium enema, or lower
gastrointestinal (GI) exam, is an
X-ray test of the
large intestine (colon and rectum).

The results of a barium
enema are usually ready right after the test or within a few
days.

Barium enema
Normal:

The colon looks normal.

Abnormal:

One or more problems in the colon are
found, such as:

  • A section of colon that did not fill with
    barium.
  • A narrowing (stricture) in the
    bowel.
  • Polyps or growths on the inner wall of the
    colon.
  • Sacs in the colon wall (diverticulosis).
  • Problems with defects and
    swelling (colitis) of the lining of the colon.
  • A narrowed
    segment or a twisted loop of bowel, causing an
    obstruction.
  • Telescoped bowel in a child, which is a sign of
    intussusception. The barium enema may be used as a treatment to return the
    bowel to its normal position.

Many conditions can change barium enema test results. Your
doctor will discuss any important abnormal results with you in relation to
your symptoms and past health.

What Affects the Test

You may not be able to have the test, or the results may not be helpful, if:

  • There is stool or gas in your colon.
  • You have muscle
    spasms in the colon wall.
  • You have severe ulcerative colitis, toxic megacolon, or acute
    diverticulitis, or your doctor thinks you may have a perforation of the intestine.
  • You are pregnant.
  • You aren’t able to stay still or to cooperate
    during the test.
  • You are extremely overweight.
  • You have had a barium swallow test (upper gastrointestinal series) within a week before this test.

What To Think About

  • If your doctor thinks you have an abdominal mass, other tests
    may be needed before or after a barium enema. These include abdominal X-rays,
    ultrasound studies, and
    CT scans.
  • If an
    upper gastrointestinal series is planned, it should be done after the
    barium enema. The barium swallowed during an upper GI series may take several
    days to pass through the intestine. This can interfere with the results of a
    barium enema.
  • In most cases, a barium enema is not used to screen for colon cancer. Other tests are used instead.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Jerome B. Simon, MD, FRCPC, FACP – Gastroenterology

Current as ofOctober 9, 2017