Barium Enema Procedure

Why do doctors order barium enema?

A barium enema is most commonly ordered when a colonoscopy is incomplete or when a patient can’t tolerate a colonoscopy.

Barium enema can also be done for symptoms like diarrhea, chronic constipation, blood in stools, and irritable bowel syndrome.

Barium enema is currently not commonly done because of the widespread availability of colonoscopy.

Barium enema prep

A prep for barium enema may involve a clear liquid diet the day before.  Laxatives and enema may be needed as well.  The colon must be free of stool as this can mimic abnormalities.  The facility where you are having the test will provide specific instructions.

What can barium enema diagnose?

Barium enema can diagnose abnormal growths like polyps and  cancer.

We can diagnose narrowing or blockage of the colon.

Inflammatory conditions like colitis can be diagnosed.

Fistulas or abnormal communication of the colon with other structures can be diagnosed.

Colon leaks can be diagnosed.   Water soluble contrast is preferred to barium when this is suspected.  Barium can cause inflammation when it leaks outside the colon.

What can barium enema miss?

Barium enemas can miss significant pathology.   This will depend on how good the prep is for the colon, the technique used, and the experience of the radiologist.

Single contrast barium enema

A single contrast barium enema is done only with barium.  No air is introduced into the colon during the procedure.

Double contrast barium enema

A double contrast barium enema is done with both barium and air introduced into the colon.  This provides more detail of the colon and allows more abnormalities to be detected.

Air contrast barium enema

This is another way of saying that the barium enema is a double contrast exam.  This means that we introduce barium and air into the colon.

Barium enema procedure

An X-ray is initially done of the abdomen to make sure there is no significant quantity of retained stool in the colon.   The lower GI exam is done in the radiology department. A radiology doctor will perform the exam and a technologist will assist him.

You will be placed on a flat fluoroscopy table.  Fluoroscopy is a continuous form of X-ray. A small tube will be placed into your rectum.  This will allow the barium contrast to flow into your colon.

The radiologist will closely evaluate the colon for any abnormalities using X-ray after introducing the barium contrast.  The radiologist will also place air into the colon so that it can be distended and better evaluated.

After the barium and air is placed into your colon, you may feel some pressure and cramps. This will go away once the test is done and you let some of the barium and gas out.

Once the entire colon is filled with barium and well distended by air, the radiologist will take focused X-rays followed by more general overhead X-rays taken by the technologist. These will include different projections of the colon.

The technologist will ask you to go to the bathroom and have you try to expel the barium. He will then take an X-ray after that.

Who reports a barium enema exam?

After all the X-rays are taken, the exam is sent to the radiology doctor for interpretation. There are multiple X-rays to interpret.  The radiologist will look for polyps, masses, narrowed areas and other abnormalities. The radiologist will issue a report to your doctor with any limitations, abnormalities and recommendations.

Barium enema vs colonoscopy

A colonoscopy uses a flexible tube with a lighted camera to examine your colon.  Abnormalities can be detected, biopsied and even treated.

The exam is done under sedation and is more comfortable than a barium enema.   There is more experience with colonoscopies because they are much more frequently done.

Risks of barium enema

Allergic reactions.

Constipation or barium impaction if the barium is not removed from your body.

Colon perforation is a rare complication.

Leak of barium from the colon if there is a defect.

Barium enema: summary

A barium enema is a test done to evaluate the rectum and colon.  The test uses X-ray to evaluate the structure and function of the colon after giving barium contrast.   The test is less commonly done because of the availability of colonoscopy.  Colonoscopy allows detection, biopsy and even treatment of abnormalities in contrast to barium enema.