Barium Enema

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is a barium enema?

A barium enema is an X-ray procedure that examines your colon. The colon, also called the large intestine, is a long, hollow organ in your abdomen. It removes water from digested material and forms feces. A barium enema helps diagnose intestinal symptoms, such as changes in bowel movements, abdominal pain, or rectal bleeding.

A barium enema is also called a lower GI (gastrointestinal tract) series or lower GI tract radiography. It makes still pictures as well as moving images. It uses a special type of X-ray called fluoroscopy

The procedure involves putting barium inside the colon through a tube inserted into the rectum. Barium is a chalky metallic contrast material. It illuminates the colon to show detailed images of the inside of the colon. 

A barium enema is only one method used to diagnose colon conditions.  You may have less invasive testing options. Consider getting a second opinion about all of your testing choices before having a barium enema.

Why is a barium enema performed? 

Your doctor may recommend a barium enema is to diagnose diseases and conditions of the colon and rectum including:

  • Abdominal pain, if the underlying cause has not been found through other, less invasive tests. Abdominal pain can be caused by many conditions from inflammatory bowel disease to intestinal ulcer.

  • Abnormal changes in your bowel movements, such as chronic constipation or diarrhea

  • Anemia (low red blood cell count), if the underlying cause has not been found through less invasive testing. A barium enema can identify masses or growths in the colon which can cause bleeding.

  • Bleeding symptoms, such as rectal bleeding, bloody stool, or black, tarry feces. Potential causes of such bleeding include colon cancer and intestinal inflammation or damage.

  • Colon cancer. A barium enema can identify abnormal growths, polyps, and masses in the intestines.

  • Colon polyps, abnormal growths in the large intestine that can become cancerous

  • Diverticulosis and diverticulitis, intestinal pockets that can develop over time and become infected

  • Inflammatory bowel disease, which includes ulcerative colitis and Crohn's disease

  • Irritable bowel syndrome (IBS). A barium enema may be used to rule out other causes of IBS symptoms, such as a blockage in your intestines.

  • Unexplained weight loss, if the underlying cause has not been found through less invasive testing

Who performs a barium enema?

A radiologist and a radiologist technician perform a barium enema. A radiologist, also called a diagnostic radiologist, is a doctor who specializes in diagnosing and treating diseases and injuries using medical imaging techniques. A radiologic technologist is a medical professional who specializes in medical imaging and the care of patients during imaging procedures.

How is a barium enema performed?

Your barium enemas will be performed in a hospital radiology department, outpatient setting, or doctor’s office. Your barium enema will take about an hour. It generally includes these steps:

  1. You will dress in a patient gown and lie on an examination table.

  2. The radiologic technologist will position you on the table. The technologist will take a preliminary X-ray to make sure the colon is cleaned out well enough to take good pictures.

  3. The radiologic technologist will instill the barium mixture slowly into the colon. The barium flows through a small, lubricated enema tube inserted into the rectum. A small amount of air may be injected to help the barium spread more evenly in the colon. This makes the best images.

  4. The radiologic technologist will take a series of painless X-ray pictures. You will be repositioned as needed to get pictures of different areas of the colon.

  5. After all the X-rays have been taken, you will wait briefly while the pictures are checked for quality.

  6. The radiologic technologist takes more pictures as needed. 

  7. Most of the barium will flow out of the colon through the enema tube before it is gently removed. 

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You may feel fullness, mild pressure, or brief, minimal cramping during the procedure. You may also feel like you need to have a bowel movement. Take a few long, deep breaths to help yourself relax. Tell your care team if any discomfort does not pass quickly.

What are the risks and potential complications of a barium enema?

A barium enema involves risks and possible complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery. 

Complications of a barium enema are not common but include:

  • Barium impaction, which is a blockage of the colon caused by the barium. This is a rare event.

  • Dehydration due to taking enemas and laxatives before the procedure

  • Puncture of the colon 

  • Small risk of cancer due to radiation exposure. Your care team follows strict standards for X-ray techniques and uses the lowest amount of radiation possible to produce good images. Your doctor will generally not order an X-ray if you are pregnant due to the danger of radiation to an unborn child. Tell your doctor if there is any chance that you are pregnant.

Reducing your risk of complications

You can reduce the risk of some complications by: 

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during your recovery

  • Notifying your doctor immediately of any concerns, such as constipation, fever, pain, rectal bleeding, inability to pass gas, or bloody stool

  • Taking your medications exactly as directed. This may include a laxative or enema to wash out residual barium from your colon after a barium enema. 

How do I prepare for my barium enema?

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and help your doctor get the most accurate test results.

You can prepare for a barium enema by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Cleansing your colon as directed. This may include a combination of enemas, laxatives, and not eating solid foods or drinking on the day or night before the procedure.

  • Taking or stopping medications exactly as directed. This may include taking your usual medications with a small sip of water.

  • Telling your doctor if there is any possibility you are pregnant

Questions to ask your doctor

Preparing for a barium enema can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your barium enema and between appointments. 

It is also a good idea to bring a list of questions to your appointment. Common questions include:

  • Why do I need a barium enema? Are there any other options for diagnosing my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the procedure? When can I return to work and other activities?

  • What assistance will I need at home? Will I need a ride home?

  • How should I take my medications?

  • When and how will I get my test results?

  • When should I follow up with you?

  • When and how should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my barium enema?

Knowing what to expect after a barium enema will help you get back to your everyday life as soon as possible. 

How will I feel after the barium enema?

You may be given a laxative or enema to wash out remaining barium. You may pass extra gas that was inserted during the procedure. You should not be in pain. Tell your care team if you have discomfort that does not go away quickly or if you are in pain.

It is normal for you to have white-colored stools for a day or two after a barium enema. Call your doctor if you are constipated for more than two days or if you can’t pass gas.

When can I go home?

Patients generally go home and resume normal activities and diet right after a barium enema. You may need to drink extra water for 24 hours to keep your stools soft.

When should I call my doctor?

It is important to keep your follow-up appointments after a barium enema. Call your doctor if you have any concerns between appointments, such as:

  • Constipation
  • Fever (you should not have any fever after a minor testing procedure)
  • Pain
  • Rectal bleeding, bloody stools, or black tarry stools
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 24
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Barium Enema Examination. American Society of Radiologic Technologists.
  2. Lower Gastrointestinal (GI) Tract X-ray (Radiography). Radiological Society of North America.
  3. What is Lower GI Tract X-ray Radiography (Barium Enema)? Barnabas Health.