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Barium enema


Expert reviewer, Dr Daniel Boxer, Consultant Radiologist
Next review due October 2020

A barium enema is an X-ray examination of your large bowel (intestine). The procedure involves placing some white liquid, called barium, and some gas into your bowel via your anus and then taking X-rays. The fluid coats the inside of your bowel, allowing clearer X-ray images.

The test is usually done during an outpatient visit to the hospital radiology department. It may take about 40 minutes.

A barium enema may help your doctor diagnose conditions that affect the lining of your bowel. For example, polyps, inflammatory bowel disease and bowel cancer.

Image showing the large and small bowels

What are the alternatives to barium enema?

There are two other main ways to look for problems with your large bowel.

  • A colonoscopy. This allows a doctor to look inside your bowel using a narrow, flexible, tube-like telescopic camera called a colonoscope. For more information, see our topic on colonoscopy.
  • CT colonography (CTC). This uses X-rays to make a three-dimensional image of your bowel and is also called virtual colonoscopy. For more information, see our topic on virtual colonoscopy.

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

Preparing for a barium enema

Your hospital will give you information before your barium enema appointment to explain how to prepare for it.

To get good X-ray images, your bowel needs to be completely empty. This is so the barium can coat every part of your bowel lining. Your hospital will give you clear instructions about what to eat and drink in the days before your barium enema. These may include:

  • not eating any solid food the day before your test
  • drinking only clear liquids the day before your test
  • not drinking anything on the day of your test

If you have diabetes, you should be given some specific advice about how to keep your blood sugar up during this time.

You’ll usually also be given a strong laxative medicine to empty your bowel, with instructions on how and when to take it. Stay close to a toilet for several hours after taking the laxative and drink clear fluids to avoid dehydration.

It’s very important to follow all the bowel preparation instructions carefully.

If you usually take medicines, continue to take them as prescribed unless your doctor specifically tells you not to. Before the procedure you’ll meet your radiographer (a health professional trained to perform imaging procedures). It’s important to tell your radiographer about any medicines you’re taking, any medical conditions you have and if you have any allergies.

Tell your radiographer if you’re pregnant, or even if you might be. This is important – a barium enema isn’t recommended for pregnant women, unless there’s an urgent medical reason.

Your radiographer will discuss with you what will happen before, during and after your procedure. This is your chance to ask any questions you have. If you don’t want to have the procedure, you don’t have to. If you’re happy to go ahead, they’ll ask you to sign a consent form.

What happens during a barium enema?

The test usually takes around 40 minutes. You can take someone to the hospital with you, but they probably won’t be able to come into the X-ray room. A member of staff will explain what’s going to happen. If you have any questions, just ask.

You’ll be asked to remove your clothing and put on a hospital gown in a private cubicle. You’ll 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 medicine to help relax the muscles of your bowel wall. (You may not have this injection if you have glaucoma or heart problems.)

Your radiographer or radiologist will gently pass a soft plastic tube into your anus (bottom). During the examination, the barium will flow through the tube to coat your bowel wall. Your radiographer or radiologist will also gently pump air through the tube to expand your bowel. This makes your bowel wall easier to see. You may find this uncomfortable, 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.

Your radiographer or radiologist will take several X-ray pictures with you in different positions. It’s important that you try to stay as still as possible when you’re asked to do so. This helps make sure that the pictures are clear. When your radiographer or radiologist has recorded enough images, they’ll remove the tube. Most of the liquid that went into your bowel would have been removed through the tube before it came out. You’ll be shown straight to the toilet to pass out the rest.

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

What to expect afterwards

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

You’ll usually be able to go home when you feel ready. It’s best to get someone else to drive you home. If you have to drive yourself, be aware that any muscle relaxant medicine you had may cause temporary blurred vision. Don’t drive until your vision is back to normal.

Take it easy at home and stay within easy reach of a toilet for the first few hours. You may notice that your stools (bowel movements) look white for a day or so – this is normal.

You can go back to your usual diet, and try to drink plenty of clear fluids to avoid constipation. There aren’t usually any problems after a barium enema, but your radiographer or nurse will tell you who to contact if you have any concerns.

A report will be sent to the doctor who requested your test. This can take up to two weeks to reach your doctor.

What are the risks?

As with every test, having a barium enema has some risks. Your doctor will have recommended the test because they believe the benefits for you outweigh the risks. You can ask them to discuss the risks and benefits with you. It’s your decision whether to go ahead with any procedure your doctor offers.

X-ray radiation

Having a barium enema exposes you to some X-ray radiation. In all X-ray examinations, the amount of radiation is kept to the absolute minimum that’s necessary. The level of exposure from having a barium enema is about the same as you’d get naturally from the environment over three years.

If you’re pregnant

If you’re pregnant, doctors usually say you shouldn’t have X-ray tests of your abdomen (tummy). This is because there’s a risk that the radiation may cause some damage to your unborn child, particularly in early pregnancy. It’s important to tell your doctor or radiographer if you’re pregnant, or if there’s even a chance you might be.

Side-effects

Side-effects are the unwanted but mostly temporary effects of the procedure.

After having a barium enema:

  • you may feel bloated and get some mild cramps for a short while.
  • you may become constipated for a few days and may need to take a mild laxative.
  • your stools (bowel movements) may appear white for a day or two.

The muscle relaxant that’s 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. These are rare after a barium enema, and your doctor will only recommend this procedure if the benefits to you outweigh the risks. Complications may include the following.

  • During a barium enema, there’s a very small chance of barium leaking through a tear or hole in your bowel. You would need surgery to mend this. For this reason, you won’t be offered a barium enema if you already have an inflamed or weakened bowel wall.
  • You may get an allergic reaction to the barium, but this is rare.
  • The barium may cause a blockage in your bowel, but again this is rare.
  • There’s always a slight chance that a procedure involving X-rays can cause cancer.

Frequently asked questions

  • 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).

    Your radiologist will write a report to say what the images show. They’ll send this report to the doctor who asked for the barium enema to be done. This can take up to two weeks.

    When your hospital doctor or GP refers you for a barium enema, ask them to tell you how and when you’ll get the results. The radiographer or radiologist who does the barium enema may also be able to tell you when the results are likely to be ready.

  • If you have symptoms which may be caused by problems in your large bowel, there are several main tests your doctor may recommend. These include colonoscopy and CT colonography – see our section on alternatives to barium enema above. A barium enema test is used less often than it used to be.

    However, a barium enema is still sometimes a useful test for looking at the lining of your large bowel. Local hospitals usually have the staff and equipment to offer a barium enema. They have radiographers and radiologists who are experienced in performing and interpreting the test. And barium enemas have a proven safety record.

    Your doctor can explain why a barium enema may be the best option for you in your particular circumstances.


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Related information

    • X-ray (radiography) – lower GI tract. RadiologyInfo.org. www.radiologyinfo.org, reviewed 1 March 2017
    • CT colonography. RadiologyInfo.org. www.radiologyinfo.org, reviewed 17 March 2016
    • X-ray, interventional radiology and nuclear medicine radiation safety. RadiologyInfo.org. www.radiologyinfo.org, reviewed 5 April 2017
    • Barium enema. Cancer Research UK. www.cancerresearchuk.org, last reviewed 24 August 2015
    • Colonoscopy. Cancer Research UK. www.cancerresearchuk.org, last reviewed 19 February 2016
    • Barium enema. Cancer.Net. www.cancer.net, approved April 2017
    • Barium enema. PatientPlus. patient.info/patientplus, last checked 15 October 2014
    • Colorectal assessment. OSH Colorectal surgery (online). Oxford Medicine Online. www.oxfordmedicine.com, published October 2011
    • Patient dose information: guidance. Public Health England. www.gov.uk, published 4 September 2008
    • Hyoscine butylbromide. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 17 October 2017
    • Guidance on the use of CT colonography for suspected colorectal cancer. British Society of Gastrointestinal and Abdominal Radiology (BSGAR) and the Royal College of Radiologists, 2014. www.rcr.ac.uk
    • 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
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, October 2017
    Expert reviewer, Dr Daniel Boxer, Consultant Radiologist
    Next review due October 2020



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