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Barium enema

Barium enema involves placing fluid containing barium (a substance which shows up on X-rays) into your bowel via your rectum. The fluid coats the inside of your bowel allowing clearer X-ray images.

You will meet the radiographer carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

A barium enema helps produce clearer X-ray images of your large bowel (colon and rectum). The procedure involves placing a white liquid called barium into your bowel via your rectum and then taking X-rays.

X-rays usually pass straight through your bowel and so it doesn’t show up well on plain X-ray images. However, if your bowel wall is coated with barium, the outline of your bowel shows up clearly on X-ray images.

The test is often done as an outpatient procedure in a hospital's imaging or radiology department. It’s usually carried out by a radiographer (a health professional trained to perform imaging procedures). A radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions) may also be present to interpret the images.

A barium enema is particularly useful for helping your doctor diagnose conditions that affect the lining of your bowel. For example, polyps, diverticular disease and bowel cancer.

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Details

  • Preparation Preparing for a barium enema

    Your radiographer will explain how to prepare for your examination.

    To get good X-ray images, it's essential for your bowel to be completely empty. This is so the barium, which acts like a temporary paint, can coat every part of your bowel lining. To achieve this, you will be asked:

    • not to eat any solid food the day before your test
    • to drink only clear liquids the day before your test
    • not to eat or drink anything on the day of your test

    You will usually be given two doses of a strong laxative to empty your bowel. You will receive instructions on how and when to take it. Stay close to a toilet for several hours after taking the treatment and drink clear fluids to prevent getting dehydrated.

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

    If you usually take medicines, continue to take them as prescribed unless your doctor specifically tells you not to. 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 take tablets or insulin for diabetes, you will be given some specific advice about what to do before the test.

    If you're a woman of childbearing age, you will be asked if you're pregnant. A barium enema isn't recommended for pregnant women, unless there is an urgent medical reason. It’s important to tell your radiographer if you could be pregnant.

    Your radiographer will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

  • Alternatives What are the alternatives to barium enema?

    There are several alternative procedures to a barium enema. These are listed below.

    • CT colonography (CTC). This uses X-rays to make a three-dimensional image of your bowel and is also called virtual colonoscopy.
    • MRI (magnetic resonance imaging). This uses magnets and radiowaves to produce images of your bowel.
    • A colonoscopy. This allows a doctor to look inside your bowel using a narrow, flexible, tube-like telescopic camera called a colonoscope.

    You may need to have a combination of tests before your condition is diagnosed. Your doctor will explain the options available to you.

  • The procedure What happens during a barium enema?

    The test usually takes around 15 to 20 minutes, but you will probably be in the radiology department for up to an hour.

    You will be asked to remove your clothing and put on a hospital gown in a private cubicle. You will then 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. This may be done either at the start or during the procedure. If you have glaucoma, you should tell your radiographer so he or she can give you a different injection.

    Your radiographer or radiologist will gently pass a soft plastic tube into your rectum. During the examination, the barium will flow through the tube to coat your bowel wall. Your radiographer or radiologist will also gently pump air or carbon dioxide gas through the tube to expand your bowel. This makes your 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 to hold the barium fluid and air in.

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

    Your radiographer or radiologist will take several X-ray images, or a moving series of images, with you in different positions. It’s important that you stay still when you’re asked to do so. This ensures that the images are clear. When your radiographer or radiologist has recorded enough images, he or she will remove the tube. You will then be shown to the toilet facilities to pass out the barium.

    Your radiographer may then take further X-ray images after you’ve passed the barium.

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  • Aftercare What to expect afterwards

    You may have cramp-like pains that continue for a short while after the procedure.

    You will usually be able to go home when you feel ready. If you were given a muscle relaxant, wait at least an hour before driving.

    Take it easy at home and stay within easy 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 will help to maintain regular bowel movements and prevent constipation.

    A report will be sent to the doctor who requested your test. This usually takes around one week to reach your doctor.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with having a barium enema. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your radiographer or radiologist to explain how these risks apply to you.

    You will be exposed to some X-ray radiation during the procedure. In all X-ray examinations, the amount of radiation is kept to the absolute minimum that is necessary. The level of exposure from having a barium enema is about the same as you would receive naturally from the environment over about three years.

    If you're pregnant

    If you’re pregnant, you’re generally advised not to have X-ray tests of your abdomen. This is because there is a risk that the radiation may cause some damage to your unborn child, particularly in early pregnancy. Tell your doctor or radiographer if there is a chance you could be pregnant.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

    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. Your faeces may appear white for a day or two.

    The muscle relaxant that is commonly used for this test can temporarily blur your eyesight. It can also give you a dry mouth and make it harder than usual to pass urine – and/or make you need to go more urgently.

    Complications

    Complications are when problems occur during or after the procedure.

    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 already have an inflamed or weakened bowel wall.

    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.

  • FAQs FAQs

    Is it safe to have barium inside my bowel?

    Answer

    Yes, it's generally safe to have barium inside your bowel but it may give you a few side-effects.

    Explanation

    Barium is a white liquid that shows up on X-ray images. It's safe for you to have barium inside your stomach or bowels, but it may cause you to have mild constipation. You might also notice that it turns your faeces white. This should only last for a day or so and your faeces will return to normal once the barium has passed through.

    Contact your GP if these side-effects continue for more than two days. He or she may give you a laxative to help your bowel get rid of the barium more quickly.

    Who interprets my barium enema results?

    Answer

    The images produced during your barium enema will be examined by a radiologist, a doctor who specialises in using imaging methods to diagnose medical conditions.

    Explanation

    A radiologist will write a report based on the images recorded during your barium enema. Most hospitals in the UK now use digital equipment to record the images, which means they are stored on computer rather than film. If you have been sent for a barium enema by your GP, he or she will receive the report.

    The amount of time it takes for your results to come through to your referring doctor will depend on why you're having the test. If your results are urgent, your GP will ensure that he or she makes a note on the scan request form and your results will arrive sooner.

    Aren't barium enemas old-fashioned?

    Answer

    A barium enema is a useful test, particularly in helping to diagnose conditions affecting the bowel. It has a proven safety record and is inexpensive for local hospitals to provide.

    Explanation

    A barium enema is an important test for looking at the lining of your large bowel. Some people may find the test a little undignified and a bit embarrassing. However, it has a proven safety record.

    Local hospitals usually have the staff and equipment to offer the test. They have radiographers who are skilled in performing the test and radiologists – doctors who specialise in using imaging methods to diagnose medical conditions.

    Virtual colonoscopy (also called CT colonography) is proving to be a good alternative to barium enema. Studies have shown that virtual colonoscopy is more effective than barium enema at finding bowel cancers and precancerous polyps. However, there is a risk it could lead to unnecessary follow-up tests because of its ability to detect very small (or unimportant) changes.

    Virtual colonoscopy may not be so readily available, or may be unsuitable for you. Ask your GP about the different types of tests available and which one may be best for you.

  • Resources Resources

    Further information

    Sources

    • Information for patients having a barium enema. The Royal College of Radiologists. www.rcr.ac.uk, published December 2010
    • Lower gastrointestinal (GI) tract X-ray (radiography). RadiologyInfo.org. www.radiologyinfo.org, published 3 March 2013
    • Barium X-ray. Cancer Research UK. www.cancerresearchuk.org, published 6 August 2013
    • Canon CL. Is there still a role for double-contrast barium enema examination? Clin Gastroenterol Hepatol 2008; 6(4):389–92. doi:10.1016/j.cgh.2007.12.051
    • Flying through the colon – the development of computed tomography (CT) colonography. The Royal College of Radiologists, 2011. www.rcr.ac.uk‎
    • Herrmann KA, Zech CJ, Michaely HJ, et al. Comprehensive magnetic resonance imaging of the small and large bowel using intraluminal dual contrast technique with iron oxide solution and water in magnetic resonance enteroclysis. Invest Radiol 2005; 40(9):621–9
    • Barium enema examination. American Society of Radiologic Technologists. www.asrt.org, published 2009
    • Protection of pregnant patients during diagnostic medical exposures to ionising radiation. Health Protection Agency, March 2009. www.hpa.org.uk
    • National strategy for radiology image and report sharing. The Royal College of Radiologists, March 2009. www.rcr.ac.uk
    • Laxatives. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 14 November 2013 (online version)
    • Picolax. Summary of product characteristics (SPC). The electronic Medicines Compendium (eMC). www.medicines.org.uk, published 16 September 2013
    • CT scans are the best alternative to colonoscopy to investigate bowel cancer symptoms: press release. Cancer Research UK. www.cancerresearchuk.org, 14 February 2013
    • Antimuscarinics. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 14 November 2013 (online version)
    • Contrast materials. RadiologyInfo.org. www.radiologyinfo.org, published 7 March 2013
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