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Barium enema

Published by Bupa's health information team, July 2009.

This factsheet is for people who are considering having a barium enema. Your care may differ from what is described here because it is adapted to meet your individual needs.

About barium enema

A barium enema is a test that uses X-rays to examine the large bowel (colon and rectum).

The bowel contains air and so it lets most X-rays pass through easily. This means it doesn't show up well on plain X-ray images. However, if the bowel wall is coated with barium, a white liquid that X-rays don't pass through, the lining of the bowel shows up clearly on X-ray images.

The test is routinely done as an out-patient procedure in a hospital's imaging or radiology department. It will probably be carried out by a radiographer (a health professional trained to perform imaging procedures) and a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions) may also be present.

You may need to have a barium enema to find out more about what is causing symptoms such as:

The test is particularly useful for helping to diagnose conditions that affect the lining of the bowel, including polyps, diverticular disease and cancers of the colon or rectum.

What are the alternatives?

Alternative imaging procedures include computerised tomography (CT) and magnetic resonance imaging (MRI). Doctors can also get very valuable information using a test called a colonoscopy. This looks directly at the lining of the bowel, using a narrow, flexible, tube-like telescopic camera called a colonoscope. You may need to have a combination of tests to help make a firm diagnosis.

Preparing for your barium enema

If you usually take medication (for example, tablets for blood pressure), continue to take this as prescribed unless your doctor specifically tells you not to.

To get good X-ray images, it's essential for your bowel to be completely empty so that the barium, which acts like a temporary paint, can coat every part of your bowel lining. To achieve this, you will be asked to eat no solid food and drink only clear liquids for 24 hours before your test.

You will usually be given two doses of a strong laxative to cleanse the bowel. You will receive detailed instructions on how and when to take it. Follow these instructions carefully even if they are different to the advice in the patient information leaflet that comes with the laxative.

The laxative effect can be quite powerful and you will probably pass lots of watery faeces. You will need to stay close to a toilet for several hours after taking the treatment. To prevent dehydration while this is happening, try to drink about 250ml (about half a pint) per hour of water or other clear fluids. You will usually be allowed to drink clear fluids until immediately before the test.

It's important that you follow the bowel preparation instructions carefully. If your bowel isn't completely empty, the images obtained will be incomplete and you may need to have the test again.

It's important to tell your radiographer about any medicines you're taking and if you have any allergies, glaucoma or heart disease. If you're a woman of childbearing age, you will be asked if you're pregnant.

This test isn't recommended for pregnant women, unless there is an urgent medical reason. Please tell your radiographer if you could be pregnant.

Your radiographer will explain the procedure and ensure that you're happy to proceed with the test.

If you have diabetes

If you take tablets or insulin for diabetes, you will be given some specific advice about what to do before the test. This generally involves a reduced diet of low-fibre foods and changes to your insulin or tablet doses. If you feel a 'hypo' coming on while on the diet, drink a sugary drink or suck boiled sweets. If you have diabetes that is controlled by your diet, follow the standard advice for people who don't have diabetes.

About the procedure

The test usually takes 15 to 20 minutes, but you will probably be in the radiology department for approximately 30 to 45 minutes.

In a private cubicle, you will be asked to remove your clothing and put on a hospital gown. You will be taken to the X-ray room and asked to lie down on the X-ray table.

You may be given an injection of a muscle relaxant to help relax the muscles of your bowel wall and make the examination less uncomfortable. You may be given the muscle relaxant routinely at the start of the procedure, or only if bowel spasm is seen during the examination.

A soft plastic tube is gently passed into your rectum (the lower part of your bowel where faeces collect).

During the examination, the barium will flow through the tube to coat your bowel wall. Air or carbon dioxide gas will also be gently pumped through the tube to expand the bowel and make the bowel wall easier to see. You may find this slightly painful but it won't last for long.

You may feel as if you want to open your bowels. However, it's important to try and hold the barium fluid and air in by keeping the muscles of your bottom very tight.

Images of your bowel will be displayed on a TV screen and you will be moved into different positions, both to help the barium flow and to see as much of the bowel as possible. The X-ray table will slowly tilt to get you into position.

Several X-ray images, or a moving series of images, will be taken with you in different positions. When the radiographer or radiologist has recorded enough images, the tube will be removed.

This procedure may cause some discomfort. You may have cramp-like pains for a short while.

What to expect afterwards

You will probably want to go to the toilet and pass out the barium when the procedure is over. When you feel ready, you can go home.

If you were given muscle relaxants, wait an hour before driving. It's best to arrange for someone to drive you home.

Take it easy at home and stay within reach of a toilet for the first few hours. Try to drink clear fluids - enough so that you aren't thirsty - and eat vegetables, fruit and high-fibre foods. This helps to maintain regular bowel movement and prevent constipation.

A report will be sent to the doctor who requested your test. This can take several days to reach him or her.

What are the risks?

Barium enemas are commonly performed and generally safe. In order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications for this procedure.

You will be exposed to some X-ray radiation. The level of exposure is about the same as you would receive naturally from the environment over about three years. This is more radiation than from having an X-ray image taken of your abdomen, but less than you would receive from a CT scan of your abdomen and pelvis.

If you are pregnant

Pregnant women are generally advised not to have X-ray tests of the abdomen as there's a risk the radiation may cause some damage to the unborn child, particularly in early pregnancy. If you could be pregnant, please tell your doctor or radiographer.

Side-effects

These are the unwanted but mostly temporary effects of a successful test. After having a barium enema you may feel bloated for a short while. You may also feel constipated for a few days and may need to take a mild laxative. You can buy these over the counter at a pharmacy. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

The muscle relaxant that is commonly used for this test can temporarily blur your eyesight, give you a dry mouth and make it harder than usual to pass urine. These effects usually wear off after about 15 to 30 minutes.

Complications

Complications are when problems occur during or after the procedure.

It's very rare, but you may have a reaction to the bowel cleansing preparation. This could include dehydration and the loss of too many salts from your body, which can cause you to collapse or have a fit.

During the test, there is a very small chance that your bowel may be damaged or perforated. For this reason, you won't be offered a barium enema if you may already have an inflamed or weakened bowel wall.

Ask your doctor to explain how these risks apply to you. The exact risks will differ for every person.

Related topics

Further information

Sources

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009