A barium enema is the common name for a series of specialized x-rays of the colon and rectum. The procedure is also known as a lower GI series. In order to get the best possible x-ray images, a liquid containing barium sulfate is introduced into the rectum as an enema. In some cases, air is also given along with the enema solution. Once the enema is complete, the x-ray images are taken, and the radiologist is able to visualize the dimensions of the lowest portions of the GI tract.
The barium enema should fill the lower colon and rectum completely, showing the internal dimensions of the area. An abnormal result would include a blockage or mass in the intestine, bulges in the side of the intestine, growths in the intestine, or, in small children, the intestine may telescope back onto itself, a condition called intussusception.
The barium enema is typically performed when there is a suspicion of a lower intestine or rectal problem. This may be due to pain, bloody stool or digestive problems.
Why is a Barium Enema Necessary?
A barium enema is less common than it was years ago, largely because other tests are used instead. In many cases, a colonoscopy is performed instead of a barium enema. A colonoscopy requires the insertion of a small instrument called a colonoscope that has a camera and a light on the end that is moved through the lower GI tract. This allows the physician to visually inspect the colon and rectum from the inside. The colonoscopy is generally considered to provide more information and is done more frequently than the barium enema.
When appropriate, the barium enema is used as a less invasive method of visualizing the dimensions of the inside of the colon. It is also used when the colonoscopy results are inconclusive or show the presence of an undetermined problem. For these patients, a barium enema is often the next stem for an accurate diagnosis.
Preparing for a Barium Enema
In order for the barium enema to work properly, the intestine and rectum must be empty, which allows the enema to expand and move throughout the lower gastrointestinal tract. In order to make sure the GI tract is empty for the procedure, a bowel cleansing process must be completed.
The bowel preparation process typically involves not eating after lunchtime the day before the test. Then the patients drinks a solution a that causes bowel movements. The patient continues to drink until there is no more stool in the GI tract, and refrains from eating until the barium enema is completed.
How to: "Bowel Prep"
How is the Barium Enema Performed?
Once you have changed into a hospital gown, the procedure begins with an x-ray that will determine if your bowel preparation completely emptied your colon. Anesthesia is not needed with this procedure. In rare cases a medication may be given to help relax you during the process, such as Versed, but this is an exception rather than the rule.
If the colon is empty, you will lay on your side on the table, and the enema will be administered by a member of the healthcare team. A slender nozzle is inserted into your rectum and the fluid is gently pushed into your body. A balloon on the end of the enema helps hold the fluid inside your body during the test.
Once the enema is complete and fills the lower portion of the digestive tract, a series of x-rays are performed. You will be asked to turn from side to side during the procedure, so that multiple x-rays can be obtained from various angles.
The procedure is not painful, but can be uncomfortable. Some people experience minor cramping. You may feel a sensation of fullness, or you may have the urge to use the bathroom. Once the x-rays are complete, the balloon on the enema will be deflated and most of the fluid will be removed, you will then be able to use the restroom if you have the urge.
Risks of Barium Enema
The procedure is done using the minimum amount of radiation necessary to produce the x-ray images and is very low risk. That said, pregnant women and children are more sensitive to radiation and should avoid any type of radiation when possible, except in cases where the risks of the procedure are outweighed by the rewards of diagnosis.
The insertion of the enema, in rare cases, can perforate the delicate tissues of the GI tract, a serious complication that can result in the barium solution leaving the GI tract and entering the abdominal cavity of the body.
After a Barium Enema
Once the procedure is done you can return to your normal activities and resume your normal diet. You may notice that your stool is white in color for a few days, this is the remaining enema fluid leaving your body.
Barium Enema. Medline Plus. Accessed November, 2013. http://www.nlm.nih.gov/medlineplus/ency/article/003817.htm