A barium enema test is a diagnostic procedure that uses a contrast agent called barium to produce x-ray images of your lower gastrointestinal (GI) tract. If you receive an air contrast (double contrast) barium enema, air will also be used as a second contrast agent to expand the colon and produce a better picture. A fluoroscopy is used to see the contrast dye inside the GI tract. The barium solution highlights the areas of tissue being examined in order to show a clear picture of the colon.

Exam results can detect problems within your lower digestive system, including the large intestine (large bowel), colon and rectum, which helps your doctor identify problems, with minimal risk and discomfort to you.

Why are Barium Enemas Done?

A physician may order a barium enema to examine the colon and aid in diagnosis of certain conditions, such as inflammatory bowel disease or polyps.

Common signs and symptoms that might require a barium enema include:

• Rectal bleeding
• Chronic diarrhea
• Chronic constipation
• Change in bowel movements
• Abdominal pain
• Bloody stool
• Sudden weight loss

Common conditions that might require a barium enema include:

• Crohn's disease
• Ulcerative colitis
• Colon cancer
• Irritable bowel syndrome (IBS)
• Diverticulitis/Diverticulosis

Barium Enema vs. Colonoscopy

A barium enema is different than a colonoscopy in that a colonoscopy can see greater detail of the colon using a scope. Colonoscopy is used to detect polyps and screen for colon cancer. A barium enema shows any abnormalities in the colon and rectum. 

How Do I Prepare for My Exam?

Your doctor will provide you with instructions for preparing for the examination but the preparation will include:

1. Disclose all medications: Provide a list of medications to your doctor at least a few weeks before the exam. Your physician will advise you on whether to continue or stop the medication for the procedure.
2. Follow a special low residue diet: Two or three days before the exam, you will be instructed to eat a low residue diet consisting of liquids, low-fat and finely crushed foods.
3. No food after midnight: You will be asked to drink only clear liquids the night before the exam and to refrain from drinking or eating anything after midnight the night before the exam. Clear liquids include water, sprite, broth, white grape juice and flavored water with no red or purple dye.
4. Take a strong laxative: Your doctor will prescribe a strong laxative to clear your lower tract the day before the exam. For the exam to be successful, your lower digestive tract must be completely empty. Any residue will show up on the images and could be mistaken for an abnormality in the colon or rectum, which is why following the instructions given by your physician’s office are very important, especially the clear liquids instruction. If preparation is incorrectly followed, your exam will be rescheduled so that proper preparation can take place.
5. Disclose all medications: Provide a list of medications to your doctor at least a few weeks before the exam. Your physician will advise you on whether to continue or stop the medication for the procedure.
6. Arrive 30 minutes prior: Please report to registration 30 minutes before your scheduled exam.

What to Expect During My Barium Enema Exam?

A radiologist or the radiology physician's assistant performs the barium enema test. These professionals specialize in the study of imaging tests, such as ultrasound and X-ray images, to assure the most accurate results for your exam.

When you arrive for your test, you will change into a hospital gown. Your technologist will gently position you on a special tilting table attached to a fluoroscope (an X-ray machine combined with a television screen). As you lie on your side, a lubricated enema tip will be inserted into your rectum and a liquid barium mixture will be released. The barium mixture will be observed on the television screen as it flows through your colon. (For air contrast (double contrast) barium enemas, air will also be released into the colon along with the barium).

As the barium fills your colon, you may feel like you need to move your bowel. Let the technologist know if you are having trouble holding the barium. You will be asked to turn from side to side and hold several different positions. After the series of barium enema x ray images are completed, you will go to the bathroom to expel the barium and an additional image will be taken after the barium has been expelled.

What Happens After My Barium Enema Exam?

Post barium enema procedure, you may be free to return to your normal activities and usual diet unless told otherwise by your physician. It is normal for the barium to give a whitish color to your stool for a day or two.

Barium may cause constipation so you will need to increase your water intake and possibly take a mild laxative. If you have trouble with constipation normally, you should consult your physician, as they may be able to prescribe a stool softener or other aids.

If you experience side effects including rectal bleeding, pain or fever, consult your physician right away.

Barium Enema Test Results

After your barium enema study is completed, the radiologist will interpret your exam and send a written report to your physician. Your physician will review the results of the test with you at your follow-up appointment.

Barium Enema Risks

The risks involved with a barium enema are far outweighed by the benefit of having a proper diagnose and treatment plan afterward. The levels of radiation absorbed from an x-ray are very low and are comparative to the security screening when flying. Some risks of a barium enema include:

• An allergic reaction to the barium contrast dye
• A tear in the wall of the colon
• Inflammation of tissue in the colon
• A bowel obstruction 

Important Information

For the exam to be successful, your lower digestive tract must be completely empty. Any residue will show up on the images and could be mistaken for an abnormality in the colon or rectum, which is why following the instructions given by your physician’s office are very important, especially the clear liquids instruction. 

If preparation is incorrectly followed, your exam will be rescheduled so that proper preparation can take place.

Inform the technologist if you may be pregnant. If there is a possibility of pregnancy, a pregnancy test will be ordered before the exam.