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Barium Enema

What is a Barium Enema?

A lower GI or barium enema, is an x-ray examination of the large intestine, also known as the colon. This includes the right or ascending colon, the transverse colon, the left or descending colon, sigmoid colon and the rectum. The appendix and a portion of the distal small intestine may also be included.

A barium enema uses a special form of x-ray called fluoroscopy and a contrast material called barium or a water soluble iodinated contrast.

Fluoroscopy makes it possible to see internal organs in motion. When the lower gastrointestinal tract is filled with barium, the radiologist is able to view and assess the anatomy and function of the rectum, colon and sometimes part of the lower small intestine.

What are some common uses of the procedure?

A physician may order a lower GI examination to detect:

  • benign tumors (such as polyps)
  • cancer
  • causes of other intestinal illnesses

The procedure is frequently performed to help diagnose symptoms such as:

  • chronic diarrhea
  • blood in stools
  • constipation
  • irritable bowel syndrome
  • unexplained weight loss
  • a change in bowel habits
  • suspected blood loss
  • abdominal pain

Images of the small bowel and colon are also used to diagnose inflammatory bowel disease, a group of disorders that includes Crohn's disease and ulcerative colitis.

How should I prepare for the procedure?

You should inform your physician of any medications you are taking and if you have any allergies, especially to barium or iodinated contrast materials. Also inform your doctor about recent illnesses or other medical conditions.

On the day before the procedure you will likely be asked not to eat, and to drink only clear liquids like juice, tea, black coffee, cola or broth, and to avoid dairy products. After midnight, you should not eat or drink anything. You may also be instructed to take a laxative (in either pill or liquid form) and to use an over-the-counter enema preparation the night before the exam and possibly a few hours before the procedure. You can take your usual prescribed oral medications with limited amounts of water.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.

How is the procedure performed?

The patient is positioned on the examination table and an x-ray film is taken to ensure the bowel is clean. The radiologist or technologist will then insert a small tube into the rectum and begin to instill, using gravity, a mixture of barium and water into the colon. Air may also be injected through the tube to help the barium thoroughly coat the lining of the colon. Next, a series of x-ray images is taken.

The patient may be repositioned frequently on order to image the colon from several angles.

Once the x-ray images are completed, most of the barium will be emptied through the tube. The patient will then expel the remaining barium and air in the restroom. In some cases, the additional x-ray images will be taken.

A barium enema is usually completed within 30 to 60 minutes.

What will I experience during and after the procedure?

As the barium fills your colon, you will feel the need to move your bowel. You may feel abdominal pressure or even minor cramping. Most people tolerate the mild discomfort easily. The tip of the enema tube is specially designed to help you hold in the barium. If you are having trouble, let the technologist know.

During the imaging process, you will be asked to turn from side to side and to hold several different positions. At times, pressure may be applied to your abdomen. With air contrast studies of the bowel (air contrast barium enema), the table may be turned into an upright position.

After the examination, you may be given a laxative or enema to wash the barium out of your system. You can resume a regular diet and take orally administered medications unless told otherwise by your doctor. You may be able to return to a normal diet and activities immediately after the exam. You will be encouraged to drink additional water for 24 hours after the examination.