What is a Barium Enema? Purpose, Procedure & Results

A barium enema is an X-ray examination of your large intestine (colon) that uses a contrast material called barium sulfate to make your intestinal walls visible on imaging. This test helps doctors see the shape, size, and condition of your colon and rectum by coating the intestinal lining with a chalky liquid that shows up clearly on X-rays.

Think of it like adding contrast to a photograph - the barium acts as a highlighting agent that makes it easier for your doctor to spot any changes or abnormalities in your digestive tract. While newer tests like colonoscopy are more commonly used today, barium enemas remain a valuable diagnostic tool in certain situations.

What is a barium enema?

A barium enema is a specialized X-ray test that examines your large intestine using barium sulfate as a contrast agent. The barium is a safe, chalky substance that you receive through a small tube inserted into your rectum.

During the procedure, the barium coats the inner walls of your colon, making them visible on X-ray images. This allows your doctor to see the outline and structure of your intestinal tract clearly. The test typically takes 30 to 60 minutes and is performed in a radiology department.

There are two main types: a single-contrast barium enema using only barium liquid, and a double-contrast (air-contrast) barium enema that combines barium with air to provide more detailed images of the colon lining.

Why is a barium enema done?

Your doctor may recommend a barium enema to investigate symptoms or monitor known conditions affecting your large intestine. This test helps diagnose various digestive problems when other methods aren't suitable or available.

Common reasons for ordering this test include persistent changes in bowel habits, unexplained abdominal pain, or blood in your stool. Your doctor might also use it to monitor inflammatory bowel conditions or check for complications after colon surgery.

Here are the main conditions a barium enema can help detect:

• Colorectal polyps (small growths on the colon wall)
• Colorectal cancer or tumors
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Diverticulosis (small pouches in the colon wall)
• Bowel obstructions or narrowing
• Hernias affecting the intestine
• Intussusception (when part of the intestine slides into another part)

Your doctor will consider your specific symptoms, medical history, and other factors when deciding if this test is right for you. Sometimes it's chosen when colonoscopy isn't possible or as a follow-up to other imaging studies.

What is the procedure for a barium enema?

The barium enema procedure happens in a hospital radiology department with specialized X-ray equipment. You'll work with a radiologic technologist and radiologist who will guide you through each step of the process.

Before the exam begins, you'll change into a hospital gown and lie on an X-ray table. The technologist will take an initial X-ray of your abdomen to check for any blockages or excess stool that might interfere with the test.

Here's what happens during the procedure:

1. You'll lie on your side while a small, lubricated tube is gently inserted into your rectum
2. The barium mixture flows slowly through the tube into your colon
3. You'll be asked to change positions (lying on your back, sides, and stomach) to help the barium coat all areas
4. The radiologist takes X-ray images from different angles
5. For a double-contrast study, air is also introduced to expand the colon for better visualization
6. You may feel cramping or pressure as your colon fills, but this is normal

The entire process usually takes 30 to 60 minutes. You'll need to hold still during X-ray exposures, but you can breathe normally. The medical team will communicate with you throughout the procedure and help you feel as comfortable as possible.

How to prepare for your barium enema?

Proper preparation is essential for a successful barium enema because your colon needs to be completely clean for clear images. Your doctor will provide specific instructions, but preparation typically begins 1-2 days before your test.

The most important part of preparation involves emptying your colon completely. This usually means following a clear liquid diet and taking prescribed laxatives or enemas as directed by your healthcare team.

Your preparation will likely include these steps:

• Following a clear liquid diet for 12-24 hours before the test
• Taking prescribed laxatives or bowel preparation solutions
• Using enemas the evening before or morning of the procedure
• Stopping certain medications that might interfere with the test
• Avoiding dairy products and high-fiber foods for several days
• Drinking plenty of clear fluids to stay hydrated

Make sure to follow your doctor's instructions exactly, as incomplete preparation can result in poor image quality and may require rescheduling the test. If you have diabetes or take blood-thinning medications, discuss any special considerations with your healthcare provider.

How to read your barium enema results?

A radiologist will analyze your barium enema images and send a detailed report to your doctor, usually within a few days. Your doctor will then explain the results and discuss any findings with you during a follow-up appointment.

Normal results show a colon with smooth, regular walls and no unusual growths, narrowing, or blockages. The barium should flow evenly through your entire large intestine, creating clear outlines of the colon's natural curves and structure.

Abnormal findings that might appear on your barium enema include:

• Polyps appearing as small, round filling defects
• Tumors or masses showing as irregular growths or blockages
• Strictures (narrowing) appearing as tight areas where barium flow is restricted
• Diverticulosis visible as small pouches extending from the colon wall
• Inflammatory changes showing as irregular wall thickness or ulcerations
• Bowel obstructions appearing as areas where barium cannot pass

Remember that an abnormal result doesn't necessarily mean cancer or a serious condition. Many findings are benign or easily treatable. Your doctor will explain what any abnormalities mean for your health and recommend appropriate next steps.

What are the risk factors for needing a barium enema?

Several factors can increase your likelihood of needing a barium enema, though the test itself is generally safe for most people. Understanding these risk factors helps you and your doctor make informed decisions about your digestive health.

Age is one of the most significant factors, as colorectal problems become more common after age 50. Family history also plays an important role, especially if close relatives have had colon cancer or inflammatory bowel disease.

Here are the main risk factors that might lead to needing this test:

• Age over 50 years
• Family history of colorectal cancer or polyps
• Personal history of inflammatory bowel disease
• Persistent digestive symptoms like blood in stool or abdominal pain
• Previous abnormal screening test results
• Certain genetic conditions that increase colon cancer risk
• Long-term smoking or heavy alcohol use
• Diet high in processed meats and low in fiber

However, having risk factors doesn't mean you'll definitely need a barium enema. Your doctor considers your individual situation, symptoms, and other available testing options when making recommendations.

What are the possible complications of a barium enema?

Barium enemas are generally safe procedures with a low risk of complications. Most people experience only minor discomfort during and after the test, with serious complications being quite rare.

The most common side effects are temporary and manageable. You might feel bloated, crampy, or have mild abdominal discomfort during the procedure as your colon expands with barium and air.

Potential complications, though uncommon, can include:

• Allergic reactions to barium (extremely rare)
• Bowel perforation (tearing of the colon wall) - very rare but serious
• Barium impaction (hardened barium blocking the intestine) - rare
• Dehydration from bowel preparation
• Temporary constipation after the procedure
• Mild rectal bleeding or irritation
• Electrolyte imbalances from preparation medications

The risk of serious complications is less than 1 in 1,000 procedures. Your medical team monitors you carefully during the test and is prepared to handle any issues that might arise. Most people tolerate the procedure well and return to normal activities the same day.

When should I see a doctor about barium enema results?

You should contact your doctor if you experience any concerning symptoms after your barium enema or if you have questions about your results. While most people recover quickly, certain symptoms warrant immediate medical attention.

After the procedure, it's normal to have white or light-colored stools for a few days as the barium leaves your system. Drinking plenty of water helps flush the barium out and prevents constipation.

Contact your doctor immediately if you experience:

• Severe abdominal pain or cramping
• Signs of infection like fever or chills
• Persistent nausea or vomiting
• Inability to pass gas or have a bowel movement
• Rectal bleeding that's more than light spotting
• Signs of dehydration like dizziness or extreme thirst
• Severe allergic reactions like difficulty breathing or swelling

For your test results, follow up with your doctor as scheduled even if you feel fine. If abnormalities were found, your doctor will explain what they mean and discuss any additional tests or treatments that might be needed.