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Barium enema is a special x-ray of the large intestine, which includes the colon and rectum.
Lower gastrointestinal series; Lower GI series
How the Test is Performed
This test may be done in a doctor's office or hospital radiology department. It is done after your colon is completely empty. Your doctor will give you instructions on how to empty your colon.
You will lie flat on your back on the x-ray table and an x-ray will be taken.
- You will then be told to lie on your side. The health care provider will gently insert a well-lubricated tube (enema tube) into your rectum. The tube is connected to a bag that holds a liquid containing barium sulfate. It is placed in the rectum.
- The liquid is a type of contrast material that highlights specific areas in the colon, creating a clearer image. The barium flows into your colon and x-ray images are taken. Eventually, the barium passes out of your body with your stools.
A small balloon at the tip of the enema tube may be inflated to help keep the barium inside your colon. The health care provider will monitor the flow of the barium on an x-ray fluoroscope screen, which is like a TV monitor.
Sometimes a small amount of air is delivered into the colon to expand it. This allows for even better images. This test is called a double contrast barium enema.
You will be asked to move into different positions and the table will be slightly tipped to get different views. At certain times when the x-ray pictures are taken, you will hold your breath and be still for a few seconds so the images won't be blurry.
The enema tube will be removed after the pictures are taken. You will be given a bedpan or helped to the toilet, so you can empty your bowels and remove as much of the barium as possible. One or two x-rays may be taken after you use the bathroom.
How to Prepare for the Test
Your bowels need to be completely empty before the exam. If they are not empty, the test may miss a problem in your large intestine that needs to be treated.
Your bowels may be emptied using an enema or laxatives, along with a clear liquid diet. You will be asked to drink plenty of clear liquids for 1 to 3 days before the test. Examples of clear liquids are:
- Clear coffee or tea
- Fat-free bouillon or broth
- Sports drinks
- Strained fruit juices
How the Test Will Feel
When barium enters your colon, you may feel like you need to have a bowel movement. You may also have a feeling of fullness, moderate to severe cramping, and general discomfort. Taking long, deep breaths may help you relax during the procedure.
Why the Test is Performed
The barium enema is used to:
- Detect or screen for colon cancer
- Diagnose or follow someone with ulcerative colitis or Crohn's disease
- Diagnose the cause of blood in stools, diarrhea, or very hard stools (constipation)
The barium enema test is used much less often than in the past. Colonoscopy is done more often now.
Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.
What Abnormal Results Mean
Abnormal test results may be a sign of:
- Colitis due to Crohn's disease
- Cancer in the colon or rectum
- Small growths that stick out of the lining of your colon, called polyps
- Small, bulging sacs or pouches of the inner lining of the intestine, called diverticulosis
- Twisted loop of the bowel (volvulus)
Other conditions under which the test may be performed:
There is low radiation exposure. X-rays are monitored to provide the smallest amount of radiation needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to x-ray risks.
A rare but serious risk is a perforated colon.
It is normal for the stools to be white for a few days after this test. You should try to drink extra fluids for 2 to 4 days. Ask your doctor about a laxative if you develop hard stools.
Bresalier RS. Colorectal cancer. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 123.
Kim DH, Pickhardt PJ. Diagnostic imaging procedures in gastroenterology. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 135.
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, and Stephanie Slon.