Barium Enema

What is a barium enema?

A barium enema is a gastrointestinal exam that takes X-rays inside your large intestine (colon). Before taking the X-rays, a healthcare provider inserts a special fluid into your rectum (this is called an enema). The fluid, called barium, is a chalky white substance that coats the inside of your intestine. This makes the images clearer. Barium is a type of contrast fluid. A barium enema is also called a contrast enema.

There are two types:

• A single-contrast enema only uses barium for contrast.
• A double-contrast enema also blows air into your colon to expand it.

Why would you have a barium enema?

You might have a barium enema if you have unexplained symptoms affecting your large bowel, like:

• Rectal bleeding or blood in your poop
• Changes in bowel habits (like how often you poop)
• Unexplained chronic diarrhea
• Unexplained lower abdominal pain
• Unexplained weight loss

The test can reveal things in your intestine that might help explain your symptoms, like:

• An anal fistula
• A bowel obstruction
• Colon polyps
• Diverticulosis
• Ulcerative colitis

A barium enema (or “lower GI series”) is just one of several tests that examine your lower GI tract. Different types of exams have different pros and cons for different people. Barium enemas aren’t as common as they used to be because other tests like colonoscopy and colonography work better, in many cases. But in others, a barium enema may have certain benefits over these tests.

For example:

• It’s more accessible than colonoscopy or colonography.
• It’s less invasive than a colonoscopy and doesn’t require anesthesia.
• You might be allergic to the contrast dye that a colonography uses, but not to barium.
• Your provider might be looking for something specific that’s easy to see on an X-ray.

How does a barium enema work?

X-rays (radiography) use small doses of radiation to create images of your internal organs and body tissues. A barium enema uses a special type of X-ray called fluoroscopy, which is like a video X-ray. It shows real-time movement in your organs, which can be helpful for observing how they’re working. Contrast fluids like barium make things easier to see inside. You can also watch the fluid move through your colon.

How do I prepare for a barium enema?

For the test to work, your bowel will need to be clear. Your provider will prescribe a bowel preparation to complete before the test, similar to what you would do before a colonoscopy. Most bowel prep kits come with an oral laxative and detailed instructions on how to take it. In most cases, you’ll follow a clear liquid diet for a few days before taking the laxative. Some people may receive different instructions.

Tell your provider about any current medications, supplements and health conditions, including pregnancy. They might reschedule your test or adjust your instructions, depending on your conditions.

What happens during the barium enema procedure?

A radiologist or radiology technician will perform your exam in a hospital or outpatient radiology center. A barium enema usually takes about 30 to 60 minutes. When you arrive for the procedure, you’ll change into a hospital gown. Then, you’ll lie on the exam table on your side. You won’t have sedation or anesthesia, so you’ll be fully aware and able to converse with your technicians during the test.

Your provider will:

• Gently insert a lubricated tube into your anus (butthole) and inject liquid barium through the tube into your intestine (if you have a double-contrast enema, the tube will also blow air into it)
• Take X-rays while you hold very still (sometimes, you might need to hold your breath, and your provider might ask you to move into different positions and hold them during the test)
• Deflate the balloon at the end of the tube and allow the barium to drain out (there may be a little left inside your intestine, so you’ll have a toilet or bedpan nearby so you can expel the rest)

As the fluid (and gas) fills your bowel, you may feel uncomfortably full or like you have to poop. (Don’t worry, you won’t. The balloon on the end of the tube will catch any leakage.)

What are the potential risks or side effects of the test?

Constipation is the most common side effect of a barium enema. Drinking lots of water after the procedure can help prevent this. Most cases are mild, but if it’s severe, it could obstruct your bowel.

Some bowel preps can rarely cause electrolyte imbalances or kidney injury in some people, due to the sodium phosphate in the formula. Your healthcare provider will choose an appropriate formula for you.

Other risks and complications are very rare. They include:

• Allergic reactions to the barium
• Barium leaking through a hole or tear in your intestine
• Radiation damage to you or a fetus if you’re pregnant