Listen to the Cancer.Net Podcast: Barium Enema–€”What to Expect [1], adapted from this content.

A barium enema is an x-ray examination of the colon and rectum. The colon and rectum make up the large intestine, which plays an important role in the body's ability to process waste. A barium enema outlines the colon and rectum and shows abnormalities, such as inflammation, polyps, and colon cancer.

About the procedure

An enema is a procedure that delivers liquids into the rectum and colon through the anus through a lubricated tip. Barium, which is a contrast medium (a special dye), is the liquid used in a barium enema. When an x-ray is taken, the barium shows up bright white, clearly defining the outline of the colon.

The medical team

A barium enema is performed in an x-ray room in either a hospital or a doctor's office. The test is performed by a radiology technician (a health care professional who is specifically trained in performing this kind of test) and a radiologist (a medical doctor who performs and interprets imaging tests). The radiologist interprets the results of the barium enema and diagnoses or confirms any abnormalities of the colon.

Questions to ask your doctor

Before your barium enema, consider asking your doctor the following questions:

• Why are you recommending this test?
• Who will perform the barium enema, and who else will be in the room?
• What will happen during the barium enema?
• How long will the procedure take?
• Will it be painful?
• Are there risks associated with having a barium enema?
• Will I need to avoid any activities after the barium enema?
• When will I learn the results?
• Who will explain the results to me?
• What further tests will be necessary if the results indicate cancer?

Preparing for the procedure

When you schedule the examination, you will get detailed instructions on how to prepare for your barium enema.

Tell your doctor about all medications you are taking, as well as any drug allergies, especially if you have an allergy to a contrast medium. And ask whether you should take your regular medications on the day of the examination. You will also need to tell the doctor about any medical conditions you may have. Women should tell their doctors if there is any chance that they are pregnant.

Because your colon must be empty, you will need to follow a restricted diet consisting of either soft foods or clear liquids (such as fat-free bouillon or broth, black coffee, and strained fruit juice) for one to three days before the procedure.

In addition to the restricted diet, you will need to take a laxative or give yourself an enema the day or night before the barium enema to remove waste from the colon. If your doctor prescribes a laxative, it will be given either as a pill or as a powder that you will mix with water before drinking. In either form, the laxative will make you use the bathroom frequently, so it may be a good idea to stay close to home during this time. You will not be able to eat or drink anything after midnight on the day of your examination because it is important for your colon to be completely empty to ensure a thorough examination.

During the procedure

A barium enema usually takes 20 to 30 minutes to complete. Before the procedure begins, you will be given a hospital gown to wear. You will need to remove all clothing, including underwear, jewelry, and any other metal objects that can interfere with the x-ray image. If you are a woman of child-bearing age, the radiologist will ask if there is any possibility that you are pregnant, since the test involves x-rays that expose your pelvic area to radiation, which is harmful to a fetus.

You will lie on your side on an examination table in a private room, and a sheet will be draped over your body. The examination table is attached to a fluoroscope (a special x-ray unit that is attached to a video monitor). The fluoroscope views the internal structure of the colon.

The x-ray technologist will begin the exam by performing several x-rays to make sure that your colon is empty. A well-lubricated enema tip attached to a tube will be inserted into your anus. The radiologist will then insert barium into your colon through this tube. You may be asked to move into several different positions during the test so that the barium can flow through the entire colon. Once the radiologist has determined that there is enough barium in the colon, a small amount of air may be delivered into the colon through the same tube to distend (inflate) the bowel to produce a better view of the intestinal wall; this is called a double contrast barium enema. Several x-rays will be taken during this time.

You may feel some mild abdominal pressure and cramping when the barium is flowing through the colon. Taking slow, deep breaths may alleviate this discomfort. You may also feel discomfort from lying still for an extended period. Once the barium has been inserted into the colon, you may also feel the urge to have a bowel movement. It is important for you to try to hold in the barium until the examination is complete.

After the procedure

Once the radiologist has determined that enough images of the colon have been taken, the enema tip will be removed, and you will be helped down from the table, after which you can go to the restroom to push out the barium. You will then return to the examination room for an additional x-ray to make sure that you have emptied your bowel enough.

You may notice a gray or white stool for several days after a barium enema as the remaining barium leaves your body. Since barium can cause constipation (infrequent or difficult passage of stool), you may also be asked to take a laxative to help remove any remaining barium. Be sure to drink plenty of fluids for the next several days to help prevent constipation. If you feel severe abdominal pain or have a fever, bloody bowel movements, dizziness, or weakness, call your doctor immediately.

You can expect to resume your normal activities after the barium enema, but it may be a good idea to have someone come with you to the test so that person can drive you home.

More Information

Diagnosing Cancer: Tests and Procedures [2]

Colorectal Cancer [3]

Colonoscopy–What to Expect [4]

Additional Resources

RadiologyInfo.org: Lower Gastrointestinal Tract X-ray [5]

MedlinePlus Interactive Tutorials: Barium Enema [6]

Last Updated: February 25, 2011