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A barium enema is an X-ray exam used to help diagnose certain problems in the lower bowel.

Who is a candidate for the test?

• if a person has blood in the stool or notices blood on toilet paper
• if a person has a change in bowel habits
• to evaluate the part of the colon not seen on sigmoidoscopy
• if a person has a family history of colorectal polyps or colorectal cancer
• to check the colon after surgery
• to help fix a twisted bowel
• to evaluate fever or lower abdominal pain

How is the test performed?

A barium enema can cause moderate discomfort. During this test, a person lies on the X-ray table. The person is usually asked to roll onto his or her left side. The technologist or radiologist will insert a lubricated enema tip into the rectum. The tip has a balloon that can be inflated just enough to keep liquid from leaking out.

A bag hanging on a pole holds the barium solution. This liquid is slowly passed through the bowels while X-rays are taken. The X-ray pictures are projected on a monitor. The person having the test will be asked to roll from side to side. The table may be tilted up or down, to get the best pictures. As each X-ray is taken, the person must hold his or her breath briefly.

Once the whole bowel is filled with the solution, the technologist will take more pictures with an overhead X-ray tube. Then the balloon is deflated and the enema tip is removed. The person goes to the bathroom to expel as much as possible of the barium solution. After that, he or she returns to the table so the emptied bowel can be X-rayed.

Sometimes, an air-contrast study is done, which is similar to a regular barium enema. In a one-stage air-contrast exam, the air and barium are put into the bowel together. In a two-stage exam, the barium is instilled first. The bowel is emptied and then air is pumped into it.

After the X-rays are done, the person will be asked to wait until the technologist or radiologist is sure no more X-rays are needed.

What is involved in preparation for the test?

Before the day of the test, a person will be asked to clean out the lower bowel with an oral laxative and an enema or suppository. Because every exam center has specific instructions for this, it is best to get details from the center before the exam.

Before the test starts, the person will undress completely and put on a hospital gown. All jewelry, including pierced body jewelry, must be removed. The person will be asked if he or she has any metal inside the body or if he or she has had a barium exam in the past 3 to 4 days. A woman will also be asked if she is pregnant.

What do the test results mean?

• an abscess, or pocket of pus
• abnormal narrowing or enlargement of the bowel
• colorectal polyps
• diverticulitis
• diverticulosis
• possible bleeding sites
• leakage from the bowel into the abdomen
• tumors or abnormal growths in the intestines
• a twisted bowel
• inflammatory bowel disease
• ulcers
• intussusception (the bowel telescopes into itself)
• foreign bodies in the rectum or colon