Barium Enema

Patients who have a high risk of being diagnosed with diverticulosis (colon pouches), inflammatory bowel disease (IBD) or colon cancer sometimes order an x-ray test called barium enema, also called a lower gastrointestinal series or a lower GI series, before undergoing a full colonoscopy. A barium enema is a less invasive alternative to colonoscopy, which is most effective procedure that a doctor can perform to examine your colon. While the popularity of the barium enema test has declined in recent years, many doctors will still use to barium enema to diagnose possible diseases and promote general gastrointestinal (GI) health.

How is a Barium Enema Performed?

During a barium enema procedure, the patient will lay face-up on a table while a preliminary x-ray is taken of his or her colon and rectum. Before more scans can be collected, a doctor will use an enema tube to fill the patient’s colon with a white-colored solution containing barium, which makes the tissue lining the patient’s colon show up very brightly on the final x-ray image. This not only gives the doctor a clearer view of the colon, but it also will ensure that large polyps or other irregular growths will be easily noticed during the examination, should the barium solution reveal abnormal bowel shape, position or obstructions.

The enema tube is oftentimes a cause for concern among patients scheduled to undergo barium enema. Enema tubes are small and usually do not cause much pain during insertion, although this part of the procedure can be uncomfortable for the patient. Most medical providers will lubricate the tube in order to ease the process. Connected to the enema tube is a bag full of the barium solution, which can be pumped through the rectum once the enema tube is in place. As the barium solution fills up the colon, the patient will experience a number of sensations, including getting the urge to have a bowel movement and feeling cramps in and around the abdominal area. Sometimes a tiny, inflated balloon-shaped device, also connected to the enema tube, will be inserted to prevent liquid from leaking outside of the colon during the procedure.

If the doctor has ordered a single contrast barium solution, additional x-ray images will be taken at this point. The doctor might move the patient’s body slightly while he or she lies on the table, allowing the barium solution inside the colon to move around.  But while the x-ray machine is working, the patient usually must stay completely still. If, however, the patient is undergoing a double contrast barium enema, air will also be pumped through the enema tube to inflate the colon. Having so much air enter the colon is generally an uncomfortable experience for patients, but the x-ray machine will be able to capture much more detailed pictures if the colon is expanded, which will inevitably result in a more accurate diagnosis.

After the barium enema procedure, the patient will need to use a bedpan or a toilet to try and empty his or her colon of the barium solution. Doctors may ask the patient to lie down for more x-ray images after most of the barium is gone. For a few days after the procedure, it is important that patients drink plenty of water to try and flush out residual solution as well as prevent the barium from solidifying, which could cause unhealthy bowel obstruction. Stool will generally appear white or pinkish for a few days after a barium enema procedure, which is completely normal.

How Do I Prepare for a Barium Enema?

During the days leading up to the procedure, patients must practice bowel prep, a process required before any colon screening test. Bowel prep consists of using laxatives and avoiding all solid foods for 24 hours before the colon will be examined. Only clear liquids can be consumed, such as water or apple juice. Generally, prepping the bowels takes quite a bit of effort and may cause irritability or tiredness—but completely emptying the large intestine before an examination is crucial because any residual fecal matter might look suspicious on the final x-ray scan and lead to a false diagnosis of diverticulosis, colorectal polyps or the like and may result in the patient having to have a colonoscopy anyway.

Please contact a specialist immediately if you feel you are experiencing any abnormal symptoms relating to your digestive system—or if you simply need to be screened for colon cancer or diverticulitis. Leaving GI conditions unmonitored can lead to severe complications, so take the necessary steps now to detect complication early.


Reviewed 12/29/2011 by David M. Nolan, M.D.
Diplomate of the American Board of Internal Medicine, 2011
Currently a Fellow of Gastroenterology, at UCI 2011-2014