Barium Enema

A barium enema is a diagnostic test. During the test, the doctor puts a contrast material called barium into the rectum. Enough barium is given to fill up the colon (large intestines). A plain x-ray of the abdomen is then taken.

By filling the entire cavity of the colon, the doctor can see the contour of the colon's lining. Polyps, diverticula (outpocketings), ulcers, fistula (openings), crypts (certain types of cavities), and inflammatory changes can be detected. Masses (such as tumors) are specifically of interest because this test is often used to screen for colon cancer.

• Primarily, barium enema is used to exclude diseases of the colon such as colorectal cancer. Over the years, barium enema has been used to evaluate a wide range of other conditions such as these:
  
  
  • Appendicitis
    
    
  • Celiac sprue
    
    
  • Colorectal adenoma (harmless tumors)
    
    
  • Colonic diverticula (pouches or sacs in the colon)
    
    
  • Colonic polyps
    
    
  • Crohn disease
    
    
  • Diarrhea
    
    
  • Diverticulitis of the colon
    
    
  • Chronic intestinal pseudo-obstruction
    
    
  • Lower gastrointestinal bleeding
    
    
  • Ulcerative colitis
  
  
• Although the barium enema was originally intended as a way to diagnose disease, its role has changed. Doctors use the test as a screening tool for certain people who are at risk for colorectal cancer.
  
  
• Also, a barium enema is used in some cases to treat a condition. The pressure exerted when the barium is put into the colon often results in resolving an intussusception (a telescoping effect in which the colon folds in on itself)—a condition seen in infants.
  
  
• A modified test, the double-contrast barium enema, has been developed in order to see the mucous membrane in the colon better. This is achieved by using a fluoroscope (a machine for viewing the internal structure) and by manipulating the position of the person and the amount of barium and air that is introduced.

During the barium enema procedure, the contrast material may perforate the colon and spill into the abdominal cavity. The lining of the abdominal cavity may become infected (the condition is called chemical peritonitis). The colon may narrow and become blocked.

Because of these possible problems, certain people may not be good candidates for this procedure.

The bowel is prepared before the procedure. Anyone undergoing a barium enema must be monitored during the bowel preparation procedure.

Perforation rates among the different types of enemas are probably due more to perforations that occurred prior to the enema, and the pressure exerted within the colon, rather than from the contrast material used.

• To obtain an accurate x-ray image of the contours of the colon, fecal material must be cleared. This is achieved by a cleansing enema.
  
  
  • Also, a laxative may be given orally to clear the colon of fecal material that may interfere with the procedure and the test interpretation.
    
    
  • Usually, you will not be allowed to take food or fluid after midnight the night before your procedure. You may be given fluids by IV that contain dextrose (sugar) just prior to the test.

Barium enema is performed at an outpatient x-ray center or in a major hospital. You usually go home the same day.

• When you arrive, the staff will check the last time that you had food or fluids. They will also make sure that your bowel has been prepared adequately (by the cleansing enema or laxative or both).

• You will remain awake throughout the barium enema procedure. The contrast material (barium) will be put into the rectum through a plastic tube. Aside from that discomfort, you may feel the pressure of the liquid that is being administered. Otherwise, pain should be minimal.

• Several x-rays will be taken. The duration of the whole procedure depends on the speed of the barium to fill the necessary areas of interest, the number of images required to properly evaluate the colon, and whether additional barium or images are required.

Most people have a short recovery time and go home after the procedure.

• The images are read by a qualified radiologist who communicates the findings to your doctor who may opt to see the images too. Your doctor usually calls you within a week with the results.

• If there are abnormal results such as irregularities in the contour of the colon suggesting abnormal masses, your doctor will discuss additional diagnostic and management plans, which may include biopsy or surgery.

After you leave the hospital or surgical center, expect your next bowel movement to contain the contrast material.

You should watch for abdominal pain, cramping, or vomiting. Call your doctor or seek medical attention at the nearest medical facility if you have severe symptoms.

• Call your doctor if you have any of these problems:
  
  
  • Moderate to severe abdominal pain
    
    
  • Moderate to severe abdominal bloating
    
    
  • Constipation
    
    
  • Severe diarrhea
    
    
  • Inability to take food or fluids
  
  
• If you pass dark material or have fresh bleeding in your stools, go to a hospital's emergency department.
  
  
• In addition, any severe abdominal pain, bloating, or cramping needs evaluation in a hospital.

lower gastrointestinal series, lower GI series, single-contrast barium enema, double-contrast barium enema, appendicitis, celiac sprue, colorectal adenoma, colonic diverticula, colonic polyps,  Crohn disease, diarrhea, diverticulitis of the colon, chronic intestinal pseudo-obstruction, lower gastrointestinal bleeding, ulcerative colitis polyps, diverticula, ulcers, fistula, crypts, colon cancer, colorectal cancer, intussusception, enema, barium enema

Author: Randy P Prescilla, MD, Clinical Assistant Professor, Department of Clinical Pharmacology and Toxicology, Wayne State University; Consulting Staff, Department of Pediatric Endocrinology, Children's Hospital of Michigan.

Editors: Michael D Burg, MD, Assistant Clinical Professor, Department of Emergency Medicine, University Medical Center, University of California at San Francisco-Fresno; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Anthony Anker, MD, FAAEM, Attending Physician, Emergency Department, Mary Washington Hospital, Fredericksburg, VA.