Barium enema

  • Definition
    • Barium enema is a special x-ray of the large intestine, which includes the colon and rectum.

  • Alternative Names
    • Lower gastrointestinal series; Lower GI series; Colorectal cancer - lower GI series; Colorectal cancer - barium enema; Crohn disease - lower GI series; Crohn disease - barium enema; Intestinal blockage - lower GI series; Intestinal blockage - barium enema

  • How the Test is Performed
    • This test may be done in a doctor's office or hospital radiology department. It is done after your colon is completely empty and clean. Your doctor will give you instructions for cleansing your colon.

      During the test:

      • You lie flat on your back on the x-ray table. An x-ray is taken.
      • You then lie on your side. The health care provider gently inserts a well-lubricated tube (enema tube) into your rectum. The tube is connected to a bag that holds a liquid containing barium sulfate. This is a contrast material that highlights specific areas in the colon, creating a clear image.
      • The barium flows into your colon. X-rays are taken. A small balloon at the tip of the enema tube may be inflated to help keep the barium inside your colon. The provider monitors the flow of the barium on an x-ray screen.
      • Sometimes a small amount of air is delivered into the colon to expand it. This allows for even clearer images. This test is called a double contrast barium enema.
      • You are asked to move into different positions. The table is slightly tipped to get different views. At certain times when the x-ray pictures are taken, you are told to hold your breath and be still for a few seconds so the images will not be blurry.
      • The enema tube is removed after the x-rays are taken.
      • You are then given a bedpan or helped to the toilet, so you can empty your bowels and remove as much of the barium as possible. Afterward, 1 or 2 more x-rays may be taken.
  • How to Prepare for the Test
    • Your bowels need to be completely empty for the exam. If they are not empty, the test may miss a problem in your large intestine.

      You will be given instructions for cleansing your bowel using an enema or laxatives. This is also called bowel preparation. Follow the instructions exactly.

      For 1 to 3 days before the test, you need to be on a clear liquid diet. Examples of clear liquids are:

      • Clear coffee or tea
      • Fat-free bouillon or broth
      • Gelatin
      • Sports drinks without added color
      • Strained fruit juices
      • Water
  • How the Test will Feel
    • When barium enters your colon, you may feel like you need to have a bowel movement. You may also have:

      • A feeling of fullness
      • Moderate to severe cramping
      • General discomfort

      Taking long, deep breaths may help you relax during the procedure.

      It is normal for the stools to be white for a few days after this test. Drink extra fluids for 2 to 4 days. Ask your doctor about a laxative if you develop hard stools.

  • Why the Test is Performed
    • Barium enema is used to:

      The barium enema test is used much less often than in the past. Colonoscopy is done more often now.

  • Normal Results
    • Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.

  • What Abnormal Results Mean
    • Abnormal test results may be a sign of:

      • Blockage of the large intestine (Hirschsprung disease)
      • Crohn disease or ulcerative colitis
      • Cancer in the colon or rectum
      • Sliding of 1 part of the intestine into another (intussusception)
      • Small growths that stick out of the lining of the colon, called polyps
      • Small, bulging sacs or pouches of the inner lining of the intestine, called diverticulosis
      • Twisted loop of the bowel (volvulus)
  • Risks
    • There is low radiation exposure. X-rays are monitored so that the smallest amount of radiation is used. Pregnant women and children are more sensitive to x-ray risks.

      A rare, but serious, risk is a hole made in the colon (perforated colon) when the enema tube is inserted.

  • References
    • Boland GWL. Colon and appendix. In: Boland GWL, ed. Gastrointestinal Imaging: The Requisites. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 5.

      Chernecky CC, Berger BJ. Barium enema. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. Philadelphia, PA: Elsevier; 2013:183-185.

      Taylor S, Plumb A. The large bowel. In: Adam A, Dixon AK, Gillard JH, Schaefer-Prokop CM, eds. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 6th ed. Philadelphia, PA: Elsevier; 2015:chap 29.