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 your 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.

Your doctor may order a barium enema if they suspect an abnormality in your lower gastrointestinal (GI) tract. 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

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 in the X-ray images. Tell your doctor if you’ve been having problems with your bowel movements prior to the test.

A barium enema typically takes between 30 and 60 minutes and is performed at a hospital or specialized testing facility. 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’s 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 in the bathroom.

The results are typically categorized as negative or positive. A negative result means that there were no abnormalities found. A positive result means that abnormalities were found. This usually means that further testing will be required.

Your doctor will discuss your results with you and the next steps.

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 your unborn child.

If it’s possible you have a tear, also called a perforation, 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. 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

After the exam you can go about your day as you normally would. You may resume a normal diet but you should drink lots of water and increase your fiber intake. This means increasing how much water you drink and eating foods like whole-wheat pasta, beans, peas, and raspberries. Sometimes a laxative is needed to help remove the barium.

For a few days after the procedure, you may notice that your stools are white or lighter in color than normal. This is caused by the barium and is considered normal. Your rectum and anus may be sore from the procedure.

If you have difficulty or pain with bowel movements, fever, or rectal bleeding, call your doctor. If you do not have a bowel movement for two days after the exam or are unable to pass gas, call your doctor.