Barium Enema

A barium enema is mainly a diagnostic test used to examine the large intestine (colon and rectum) for abnormalities. The test has two main parts:

1. The first is the installation of contrast material that contains barium (barium sulfate, a powder that is mixed with water resulting in a solution that decreases and/or blocks X-rays), and
2. The second consists of examining the barium-filled or barium-outlined large bowel inner surface with X-rays that are produced by a fluoroscope.

Before the test is done, individuals may require a thorough cleansing of the large bowel so that stool and gas in the bowel is removed; such cleansing insures the examination has no interfering substances. When the contrast material containing barium is introduced into the large bowel by an enema tube inserted through the anus, the barium provides contrast to the X-rays that reveal the outlines of the intestine's lumen (interior surface) and may reveal several types of abnormalities that may be present. This is termed a single-contrast study. In some patients, the barium is instilled and then removed through the enema tube leaving a thin layer of barium on the wall of the colon. The colon is then filled with air. The result provides a detailed view of the colon's interior surface and makes X-ray detection of various structures (polyps, masses), diverticula, strictures or inflammation of the bowel tissue easier to detect. This test variation is termed a double-contrast study. Barium enemas are done to identify inflammation, strictures, diverticula, inflammation and other abnormalities that may be present mainly in the large bowel.

Barium enema tests are ordered less frequently these days, since the availability of other tests like colonoscopy, CT scan, and magnetic resonance imaging (MRI) have become increasingly available and affordable. In addition, some studies suggest barium enemas may, in some instances, be inferior to other tests at discovering some large bowel problems. Most tests have advantages and disadvantages; you and your doctor should discuss which of these tests is best for you.

A barium enema may be done to identify inflammation of the intestinal wall and to find problems within the structure of the large intestine such as diverticula (sacs) intussusception (part of the intestine slides or telescopes into another part of the bowel), strictures (narrowed areas of the bowel), polyps and cancerous lesions.

In some patients with intussusception the test may be therapeutic as pressure generated during a barium enema may reverse the intussusception.

To obtain accurate X-ray images of the contours of the colon, fecal material must be cleared out of the colon. This is achieved by cleansing enema(s) and laxatives.

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 contains dextrose (sugar) just prior to the test. Most doctors have a set procedure they ask patients to follow such as when you should start and stop a clear liquid diet and what timing you should use to begin laxatives and /or enema(s) for bowel cleansing. These instructions should be followed closely.

Barium enema is performed at an outpatient X-ray center or in a major hospital. You usually go home the same day the procedure is done. You do not have to undergo anesthesia for this test but you may receive some medicine to reduce any abdominal cramping.

• When you arrive, the staff will check when it was the last time that you had food or fluids.
• 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.
• The duration of the whole procedure depends on the speed with which barium fills the necessary areas of interest, the number of images required to properly evaluate the colon, and whether additional barium or images are required. You may be asked to change your position on the table several times during the procedure. During the procedure, you will be asked to try to hold in (delay defecation) to the best of your ability for a part of the procedure time. Doctors doing the test can help you with this process. A single-contrast barium test takes about 30 to 45 minutes while a double-contrast test takes about an hour.

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

• The images are read by a qualified radiologist and/or gastroenterologist who communicates the findings to your doctor who may also opt to see the images. 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 colonoscopy, biopsy and/or surgery.

After you leave the hospital or surgical center, expect your next bowel movement to contain some of 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 abdominal symptoms after the barium enema test.

Aggressive bowel cleansing may cause hypokalemia (low potassium) and/or dehydration in some patients; the elderly are at higher risk for these complications than otherwise healthy adults.

Occasionally, the barium that remains in the colon can harden into clumps and has the potential to cause constipation or even impaction (intestinal blockage). This risk is reduced by taking plenty of fluids by mouth after the test; some radiologists recommend a post-test laxative or enema for patients.

Rarely, small clumps of barium retained in the bowel, termed barium granulomas, may cause inflammation in the colon.

During the barium enema procedure, the contrast material may rarely, 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 (individuals with weakened bowel walls that may occur with ulcerative colitis or Crohn's disease) may not be good candidates for this procedure.

• Call your doctor if you have any of these problems; if the problem(s) are severe, go to an emergency department that has consulting gastroenterologists (most large hospitals have):
  • Moderate to severe abdominal pain
  • Moderate to severe abdominal bloating
  • Constipation
  • Severe diarrhea
  • Inability to take food or fluids
• If you pass dark material (blood clots) or have fresh bleeding in your stools, go to a hospital's emergency department.