Barium Enema: Looking at the Lower Gut

A barium enema is an x-ray procedure to examine the lower gastrointestinal tract using a barium. Liquid barium is a white, chalky contrast material that helps the colon show up better on the X-ray. A barium enema is used to help diagnose diseases and other problems that affect the lower GIT. These may include abdominal (stomach) pain, bleeding, blockage, cancer (tumor), polyps (growths), or diverticula (pouches in the intestinal wall). The lower GIT is made up of the colon (large bowel) and rectum (rear end). The colon is the long tube that connects the small bowel with the anus (opening through which stool passes). The colon absorbs water from digested foods and turns the digested food into the stool. It stores the stool until it passes out through your anus.

How to Prepare
The preparation for a barium enema usually involves a very thorough cleansing of the large intestine, because the colon must be completely clear of stool and gas. Even a small amount of stool can affect the accuracy of the test.

• For 1 to 3 days before the test, you will usually be on a semisolid liquid diet.
• On the day before the test:
• You should drink very large amounts of noncarbonated clear liquids unless your doctor has advised you not to.
• You will then take a combination of laxatives to empty your intestines.
• You may be asked to take a tap water enema to clean any remaining stool from your colon.
• On the day of the test, you may need to repeat the enema until the liquid that passes is free of any stool particles. Sometimes a rectal suppository or a commercially prepared enema, such as a Kleen enema, is used instead of a tap water enema.

During the procedure

1. If you’re asked to change clothing, you’ll be given a gown to wear.
2. You will be positioned horizontally on the examination table in a side-lying position and a rectal tube will be inserted into the rectum to allow the barium to flow into the intestine.
3. The barium will be allowed to flow slowly into the intestine. You may experience cramping in the lower abdominal area as the barium is instilled. To lessen the discomfort, it may be helpful to take slow deep breaths.
4. You may feel the need to have a bowel movement. It will be important to resist the urge to prevent the barium from leaking back out. At the appropriate time, you’ll be given a bedpan or assisted to the bathroom as needed.
5. During the procedure, the machine and examination table will move and you may be asked to assume various positions as the X-rays are being taken.
6. The radiologist will take single pictures, a series of X-rays, or a video (fluoroscopy) as the barium moves through the intestine.
7. If a double contrast study is ordered, you’ll be asked to evacuate some of the barium. A bedpan or access to a bathroom will be provided. Some barium will remain in your intestine. Air is inflated via the rectum to distend the large intestine, and more X-rays will be taken.
8. Once all required X-rays have been taken, you’ll be assisted from the table.

After your procedure:
You may go back to the bathroom to pass the remaining barium and air left in your rectum. You may also lie in bed and rest for a while since the procedure may be tiring. When your caregiver sees that you are OK, you may be allowed to go.

You may resume your normal diet and activities after a barium enema unless your doctor advises you differently.

You may be advised to drink plenty of fluids and eat foods high in fiber to expel the barium from the body. Barium may cause constipation or possible impaction after the procedure if it isn’t eliminated from your body. Cathartic or laxative may be given to help expel the barium.