Barium enema

A barium enema is an imaging test that uses a contrast medium (barium) and x-rays to produce images of the large intestine. Barium is a chalky, white liquid that coats the inside of the intestine and shows its outline on an x-ray. A barium enema is also called a lower GI (gastrointestinal) series.

• In a single contrast barium enema, the colon is filled with barium to outline the intestine and show large abnormalities.
• In a double contrast barium enema, the colon is filled with barium and then drained, leaving a thin layer of barium on the wall of the colon. The colon is then filled with air. This gives a more detailed view of the inner surface of the colon.

A barium enema may be done to:

• find problems in the structure of the large intestine, such as narrowed areas (strictures) or pockets (diverticula)
• look for the cause of symptoms including blood in the stool (poop), abdominal pain, a change in bowel habits, weight loss or anemia
• diagnose or check on conditions such as ulcerative colitis or Crohn’s disease
• follow up after a positive fecal occult blood test (FOBT)
• find growths or polyps in the colon
• treat a condition called ileocolic intussusception (when the end of a child’s small intestine bulges into the large intestine)
• diagnose cancer

A barium enema is usually done as an outpatient procedure in the x-ray department of a hospital or clinic. It usually takes 20 to 30 minutes. If you are breastfeeding or pregnant or think you may be pregnant, it is important to tell the x-ray technologist before having a barium enema and x-rays.

Preparation for a barium enema usually includes:

• following a liquid diet for at least 24 hours before the test
• taking laxatives or having enemas to completely empty the intestines

You can expect the following during a barium enema:

• You will lie on an x-ray table. Barium will be given as an enema through a small plastic tube inserted through the anus into the rectum.
• A small amount of air or carbon dioxide may be pumped through the enema tube into the colon to make it expand.
• X-rays are taken as the barium moves through the colon. The x-ray table is raised and tilted different ways to spread the barium throughout the colon.
• You will be asked to hold your anus closed during the test. You may have cramps or feel like you need to have a bowel movement.
• Once the test is done and the enema tube is removed, the barium and air can be expelled.

A mild laxative may be needed to get rid of the barium and prevent constipation. Your stools may be white or lighter in colour for a few days following the test. Drinking plenty of fluids after the procedure helps flush the barium solution from the body and prevent constipation.

If you have an ostomy, you will need different preparation and testing.

There are very few side effects of a barium enema. You may feel constipated if the barium that remains in the colon hardens.

A barium enema can show:

• a blockage or narrowing in the intestine
• pockets or sacs in the wall of the colon
• a growth, such as a polyp or tumour
• growths in other organs that are pressing on the colon
• swelling or problems with the lining of the colon, such as with colitis or Crohn’s disease
• ileocolic intussusception in a child

Your doctor may recommend more tests, procedures, follow-up care or treatment.

Preparing children before a test or procedure can help lower their anxiety, increase their cooperation and develop their coping skills. This includes explaining to children what will happen during the test, such as what they will see, feel and hear.

Preparing a child for a barium enema depends on the age and experience of the child. Find out more about helping your child cope with tests and treatments.