Barium Enema

Written by Brian Krans | Published on August 15, 2012
Medically Reviewed by George Krucik, MD

What is a Barium Enema?

A barium enema is a type of X-ray imaging test that allows doctors to examine your lower intestinal tract. It involves delivering a contrast solution that contains the metallic element barium into your rectum while a technician takes X-ray images of the area. The barium solution will be delivered using an enema—a process in which a doctor pushes a liquid into your rectum through your anus.

The barium solution helps to improve the quality of the X-ray images by highlighting certain areas of tissue. The X-ray used in this procedure is known as fluoroscopy. It allows the radiologist to see your internal organs in motion by tracking the flow of the barium solution through your intestinal tract.

The test doesn’t require painkillers or sedation, but there may be moments of slight discomfort.

Why a Barium Enema Is Done

Your doctor may order a barium enema if he or she suspects there is an abnormality in your lower gastrointestinal (GI) tract, which includes your rectum and colon. There are numerous conditions and symptoms that could prompt your doctor to examine your lower GI tract, including:

  • abdominal pain
  • blood in your stools
  • a change in your bowel movements
  • Crohn’s disease
  • chronic diarrhea
  • colorectal cancer
  • diverticulitis
  • irritable bowel syndrome
  • polyps
  • rectal bleeding
  • a twisted loop of the bowels (volvulus)
  • ulcerative colitis

The Risks From a Barium Enema

Any test involving radiation carries a slight risk of cancer, including X-rays. However, the benefit of an accurate diagnosis outweighs the risks from the small amount of radiation you’ll be exposed to during the test. Remember that many things you do regularly—such as flying in an airplane—expose you to much more radiation than an X-ray.

If you are pregnant or believe you may be pregnant, tell your doctor. X-rays are not recommended for pregnant women because the radiation could harm the fetus.

If you could have a perforation (tear) in your colon, your doctor may opt for a contrast solution with iodine in it. This solution causes fewer potential complications if it leaks out of your colon.

The most common risk of a barium enema is an allergic reaction to the barium solution. So, tell your doctor about any allergies you have.

Other (rare) complications from a barium enema may include:

  • inflammation of the tissues around your colon
  • obstruction of your gastrointestinal tract
  • a perforated colon
  • a tear in your colon wall

How to Prepare for a Barium Enema

Your doctor will ask you to cleanse your bowels the night before your test. This may include using laxatives or taking an enema at home.

You shouldn’t eat anything after midnight the night before your procedure. On the day of the procedure, you can drink clear liquids, such as water, tea, juice, or broth. This is to ensure that your colon is clear of any stool, which could show up the X-ray images. Tell your doctor if you’ve been having problems with your bowel movements prior to the test.

How a Barium Enema Is Performed

A barium enema typically takes between 30 and 60 minutes and is performed at a hospital or specialized testing facility. First, you’ll change into a hospital gown and remove any jewelry or other metal from your body. Metal can interfere with the X-ray process.

You’ll be positioned on an exam table. X-rays will be taken to ensure that your bowels are clear. This may also involve a physical rectal exam.

The radiologist will then insert a small tube into your rectum and introduce the barium and water mixture. The radiologist may gently push air into your colon after the barium has been delivered in order to allow for even more detailed X-ray images. This is called an air-contrast barium enema.

The technician will instruct you to hold still and hold your breath while the X-ray images are taken. You’ll most likely be repositioned several times to take pictures of your colon from different angles. This may cause you some discomfort and cramping, but it is typically mild.

If you’re having trouble keeping the solution in your colon, alert the technician.

After the procedure, the majority of the barium and water will be removed through the tube. The rest you’ll pass yourself in the bathroom.

Following Up After a Barium Enema

Once you’ve emptied your bowels again in the restroom, you can go home. It’s best to eat something that’s easy on your stomach if you experienced discomfort during the test.

Your doctor will schedule a follow-up appointment to discuss the test results with you.

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