Barium enema

Page last reviewed: 13/07/2011

A barium enema is a special type of X-ray used to examine the large bowel (colon and rectum) for problems such as growths (polyps), inflammation (colitis), and tumours.

Normal X-rays do not provide clear images of the bowel, so a substance called barium sulphate is used to produce a clearer picture. Barium sulphate is a fine, white, odourless and non-toxic powder that, in a liquid form, coats the inside of the bowel, making it easier to see on X-rays.

How is it given?

During a barium enema the liquid barium sulphate is passed into your bowel through a small soft tube inserted into your rectum (back passage). The liquid coats the wall of your bowel. At the same time air is usually pumped through the tube to expand the large bowel. This helps to make the images as clear as possible.

If the upper gastrointestinal tract (oesophagus, stomach and small intestine) needs to be investigated, the barium sulphate can be given as a drink in a procedure known as a barium meal or barium swallow. See diagnostic endoscopy of the stomach for more information.

A barium enema and the process of taking X-ray images of the bowel takes around 15 to 30 minutes to complete. It should not be not painful but can cause some discomfort and bloating, mainly due to the large bowel stretching when the air is pumped in.

The X-ray images taken are studied and reported on by a radiologist after the appointment. A radiologist is a doctor specially trained to carry out examinations and interpret medical images, such as X-rays. A report is given to the referring doctor, usually within 14 days.

Enema

An enema is an injection of fluid into the large intestine / colon to empty the bowel. It can also be used to make the bowels show up more clearly in an X-ray.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

Stomach

The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Page last reviewed: 13/07/2011

A barium enema is commonly used to detect:

  • colon cancer,
  • cancerous or non-cancerous growths (polyps),
  • ulcers,
  • small pouches that form on the colon wall and become inflamed (diverticular disease),
  • Crohn's disease, and
  • ulcerative colitis.

Your GP may recommend that you have a barium enema if you have noticed blood in your faeces (stools), or if you have an unexpected change to your bowel movements, such as diarrhoea or constipation.

If you have a family history of colorectal polyps or colorectal cancer, and you have any unexplained lower abdominal pain, a barium enema may be used to investigate the cause.

If you are pregnant

A barium enema examination is not advisable if you are pregnant because of the use of radiation to take scans and images of your colon. The amount of radiation used during the procedure is considered safe for the patient but could be dangerous for an unborn child. It may be used only in very exceptional circumstances.

As the pelvic region is exposed to radiation during a barium enema, some hospitals will only carry out this procedure if you are within 10 days of your last menstrual cycle (LMP). The radiographer or radiologist may query this with you before the exam and ask you to sign a form to this effect. This measure absolutely excludes any possibility of pregnancy prior to the procedure

If you are pregnant, or think you might be, you must inform your doctor or radiographer at the hospital before the examination.

Glossary

Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Constipation
Constipation is when you pass stools less often than usual, or when you are having difficulty going to the toilet because your stools are hard and small.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Stools
Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.
Enema
An enema is an injection of fluid into the large intestine / colon to empty the bowel. It can also be used to make the bowels show up more clearly in an X-ray.

Page last reviewed: 13/07/2011

A barium enema is a routine outpatient procedure so you will only be in the hospital for about an hour and should be able to go home straight afterwards.

You can take a family member or friend with you but they may not be allowed into the X-ray room. It is advisable that you bring someone with you to drive you home, as you may not be able to drive straight after the procedure.

Preparations

Before having a barium enema, your bowel should be empty of any faeces (stools) to make sure clear pictures can be taken. Your doctor will advise about the type of food you can eat the day before the test.

You will also be prescribed a strong laxative to clear your bowel. Follow the instructions carefully and arrange to stay at home the day before your test to avoid any inconvenience and be as comfortable as possible.

If you are diabetic and take insulin or tablets, make sure you get enough to eat the day before your test so your blood sugar levels do not drop. Your doctor and radiologist will give you special advice as to what you can eat the day before your procedure.

What happens

You will be shown to a private cubicle where you can undress and remove any jewellery. You will be asked to put on a gown and dressing gown before being shown into the X-ray room.

You will be asked to lie on an X-ray table on your side or front, and a small soft tube is gently inserted, a few centimetres, into your rectum (back passage). You may also be given an injection, usually of Buscopan, a drug that helps to relax the muscles of the wall of the colon. Many radiologists give this injection routinely at the start of each barium enema procedure, unless you have a history of heart disease or glaucoma.

The barium sulphate liquid is passed through the tube and into your colon, and the radiologist, or radiographer, will be able to see this on a television screen. You may be asked to lie in a number of different positions to help the flow of the barium liquid, and to get it to spread evenly along the wall of the colon. Air may also be pumped into the colon to expand it and push the barium sulphate liquid inside. This may feel a bit uncomfortable (like having trapped wind).

After the barium has been passed into the colon, a number of X-ray pictures will be taken from various positions. You may be asked to stand up and lie down. As they are being taken, you will be asked to hold your breath.

The test usually takes about 15 to 30 minutes and is not painful, although you may feel a little discomfort. When the X-rays are taken the tube will be removed and the radiologist will drain as much of the barium as possible before removing the tube. You can then go to the toilet.

The test results will be sent to your GP within 14 days.

Does it hurt?

Having a barium enema should not hurt but may cause some discomfort. Some patients experience cramp-like pain during and a short while after the procedure. A full bowel during the procedure may also cause some discomfort.

Some patients worry that they may not be able to hold the barium liquid and air in their bowel. Try to hold on to it by keeping the muscles of your bottom very tight. If you let go too soon it may affect the X-ray images.

Some people release the barium on to the X-ray table. Try not to worry too much about this happening.

Afterwards

Following the procedure:

  • You will need to visit the toilet and it is advisable that you remain close to a toilet for the next few hours.
  • Your stools will appear white and discoloured for a few days. This is the barium liquid passing out of your system.
  • If you have a Buscopan injection, you will need to wait up to an hour before you drive as it can blur your vision. It is best to take someone with you to drive you home.

You can eat normally straight away following the procedure, but it is advisable to drink plenty of fluids for three days afterwards to avoid constipation.

Glossary

Enema
An enema is an injection of fluid into the large intestine / colon to empty the bowel. It can also be used to make the bowels show up more clearly in an X-ray.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Anus
The anus is the opening at the end of the digestive system where solid waste leaves the body.
Stools
Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.

The radiology department

The radiology department, or X-ray or imaging department, is an area of a hospital where radiological examinations of patients are carried out, such as X-rays, ultrasound scans, MRI and CT scans.

Radiologists are doctors that are specially trained to carry out examinations and interpret medical images, such as X-rays.

Radiologists are supported by radiographers, who are trained to carry out X-rays and other imaging procedures.

Page last reviewed: 13/07/2011

Any risks from the barium enema will be weighed up by your doctor and radiologist. If they recommend you have one, then the risk of not having it, and not diagnosing a potentially serious disorder or disease such as cancer, is much greater.

The risks during a barium enema include:

  • Radiation exposure
    During a barium enema test, you will be exposed to a relatively low quantity of radiation. The duration and level of radiation used is kept to a minimum. You will be exposed to X-rays for about two to three minutes. The quantity of radiation you are exposed to is equivalent to what you would receive naturally from the environment over about three years.
  • If you are pregnant
    A barium enema examination is not advisable if you are pregnant because of the use of radiation to take scans and images of your colon. The amount of radiation used during the procedure is considered safe for the patient but could be dangerous for an unborn child. It may be used only in very exceptional circumstances.

    As the pelvic region is exposed to radiation during a barium enema, some hospitals will only carry out this procedure if you are within 10 days of your last menstrual cycle (LMP). The radiographer or radiologist may query this with you before the exam and ask you to sign a form to this effect. This measure absolutely excludes any possibility of pregnancy prior to the procedure

    If you are pregnant, or think you might be, you must inform your doctor or radiographer at the hospital before the examination.
  • Bowel perforation
    There is a small risk of bowel perforation (a small hole in the bowel). This is a serious complication that can be fatal. It is extremely rare and generally only happens if you have a problem such as severe inflammation of the colon.
  • Side effects
    There is a risk of side effects from the drug Buscopan given to relax the muscles of your bowel wall. Your radiologist will check whether you have a history of heart disease or glaucoma before giving the injection to you. The drug can cause temporarily blurred vision. Glucagon is a drug with similar properties to Buscopan which may be used in some hospitals. Glucagon should not be used for diabetic patients.
  • Tolerance
    Some people do not tolerate barium very well and may find it gives them an upset stomach.

 

Glossary

X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Dose
Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.
Enema
An enema is an injection of fluid into the large intestine / colon to empty the bowel. It can also be used to make the bowels show up more clearly in an X-ray.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z