Barium Enema - What to Expect

September 9, 2009
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In this podcast, we'll explain what happens during a barium enema and how you can prepare for the procedure, including a list of questions to ask your doctor.


You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors that care for people with cancer.

Our topic today is what to expect when you have a barium enema.

A doctor uses a barium enema to see the inside of a person’s colon or rectum, which together make up the large intestine. It is used as a way to diagnose the cause of a problem a person is having in the colon or rectum, as well as a routine screening test for colorectal cancer for people who have no symptoms.

In this podcast, we’ll explain what happens during a barium enema and how you can prepare for the procedure, including a list of questions to ask your doctor.

Let’s begin by talking about what a barium enema is. A barium enema is an x-ray of the colon and rectum. Barium is a substance that helps show the colon better on the x-ray. During this procedure, the barium is inserted into a person’s colon before the x-ray so that when the x-ray is taken, the barium shows up bright white with a clearly defined outline of the colon.

A barium enema is performed by a specially trained radiology technician in an x-ray room at either a hospital or doctor's office. It can also be performed by a radiologist, who is a doctor trained to perform and interpret imaging tests, such as x-rays. The radiologist interprets the results of the barium enema and confirms or diagnoses any abnormalities in the colon.

When you schedule the procedure, you’ll get detailed instructions on how to prepare for your barium enema. Before the test, tell your doctor about all medications you are taking, as well as any drug allergies, especially an allergy to contrast medium. You will also need to tell the doctor about any medical conditions you may have. Talk with your doctor or nurse about whether you should take your regular medications on the day of the test.

Your colon must be completely empty for this exam, which means you will need to be on a special diet of clear liquids for one to three days before the procedure. This means eating only such foods as fat-free bouillon or broth, black coffee, strained fruit juice, and gelatin. And, you’ll not be able to eat or drink anything after midnight on the day of your procedure.

In addition to the liquid diet, you may also need to take a laxative or give yourself an enema the day or night before the test. If your doctor prescribes a laxative, it will either be given as a pill or as a powder that you’ll mix with water before drinking. In either form, the laxative will make you use the bathroom frequently. Completely cleansing your bowel will ensure a thorough examination.

Before the procedure begins, you’ll put on a hospital gown after removing all clothing including underwear, as well as all 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 because x-rays expose your pelvic area to radiation, which is harmful to a fetus.

The test itself usually takes 20 to 30 minutes. During the procedure, you’ll lie on your side on an exam table in a private room with a sheet draped over your body. The exam table is attached to a fluoroscope, which is a special x-ray machine attached to a video monitor. The fluoroscope takes pictures of the inside of the colon.

The exam often begins with several x-rays to make sure that your colon is empty. Then, a well-lubricated enema tip attached to a tube is inserted into your anus, and the radiologist inserts 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.

When there is enough barium in the colon, a small amount of air may also be inserted through the same tube to inflate the bowel. This is so the doctor can get a better view of the intestinal wall. This is called a double contrast barium enema. Several x-rays are taken during this time.

During the test, you may feel some mild abdominal pressure and cramping when the barium is flowing through the colon. Taking slow, deep breaths may ease this discomfort. You may also feel uncomfortable from lying still for a long time. Once the barium has been inserted into the colon, you may feel the urge to have a bowel movement, but it is important that you try to hold in the barium until the exam is over.

At the end of the test, the enema tip is removed and you can go to the restroom to expel the barium. Afterwards, another x-ray is taken to make sure you have emptied enough of the barium. When you are finished with the test, you’ll need someone to drive you home. Usually, you can resume normal activities immediately upon returning home.

For several days after a barium enema, you may have gray or white stool caused by the remaining barium being expelled. Since barium can cause constipation, you may have to take a laxative to help remove whatever barium is left. Be sure to drink plenty of fluids for the next several days to help prevent constipation. If you have severe abdominal pain, a fever, bloody bowel movements, dizziness or weakness, call your doctor immediately.

To better prepare for the test, consider asking your doctor the following eight questions and discuss any concerns you may have.

Question one: Why are you recommending this test?

Two: Who will perform the barium enema, and will anyone else will be in the room?

Number three: What will happen during the barium enema?

Four: How long will the procedure take? Will it be painful?

Question five: Are there risks associated with having a barium enema?

Six: What if I don't have this exam?

Seven: When will I learn the results? Who will explain the results to me?

And question eight: What other tests will be needed if the results indicate cancer?

Knowing what to expect before having a barium enema will hopefully make you more comfortable with having this test, which can provide valuable information to your doctor about your health.

For more information on this topic, contact your doctor or visit Thank you for listening to this Cancer.Net podcast.