Barium enema

This leaflet tells you about the procedure known as a barium enema. It explains what is involved and the possible risks. It is not meant to replace the discussion between you and your doctor but can act as a starting point for such a discussion. Please feel free to discuss the examination with your referring doctor (GP or specialist) or the person carrying out your examination (normally a specially trained radiographer).

What is a barium enema?

A barium enema is an x-ray examination which allows images to be taken of your colon (also called the large bowel). The colon cannot be seen very well on a normal x-ray, so it is first necessary to introduce a contrast agent to outline it better. This is done using barium (a heavy white fluid) and air, which is introduced into your colon via a small plastic tube through your rectum. This will outline your colon and make it possible to take a series of x-rays.

Why do I need a barium enema?

A barium enema is a method used to image the colon. You may have been suffering from symptoms such as weight loss, change in bowel habit, or bleeding from your rectum and your doctors feel it is wise to see if there is any cause for these in your colon.

Who has requested this procedure?

The doctors in charge of your case, after discussion with you, feel that this may help with your diagnosis.

Who will be doing the barium enema?

A radiologist or specially trained radiographer (clinician) will perform the barium enema. They will be assisted by another radiographer, assistant / student radiographer, or nurse. The x-rays will then be seen and reported on by a radiologist (a doctor specifically trained in interpreting x-rays).

Where will the procedure take place?

The procedure will take place in a room within the X-ray Department.

Please note that due to the nature of the examination we are unable to accommodate unaccompanied children within the department.

How do I prepare for a barium enema?

You will be sent a diet sheet to follow and, normally, two sachets of laxative. Instructions for taking the laxative will be included.

This examination needs you to be mobile (able to move) as you will be asked to roll from your front to your back several times. If you have any difficulties moving around, please call 01233 616033 before your appointment.

Bowel preparation

It is important that your bowel is clean before your barium enema.

The laxative used is strong, but safe for most people. You will need to stay close to a toilet when you have taken the laxative.

Please call us on 01233 616033 if you have any of the following conditions:

• severe renal disease

• congestive cardiac failure; or

• inflammatory bowel disease, for example Crohn’s disease or ulcerative colitis.

What actually happens during a barium enema?

On arrival in the X-ray Department you will be shown to a changing cubicle. You will be asked to undress and put on a hospital x-ray gown and a pair of dignity shorts. Dressing gowns are supplied to wear over these, however you may bring your own if you prefer. You will then be called into the ‘screening room’ as close as possible to your appointment time.

The clinician performing the examination will introduce themselves and explain the procedure. You may be given a small injection into a vein in your arm. This is a muscle relaxant which works on the muscles of the colon and prevents too much spasm occurring. Although it is not a sedative it should make the procedure more comfortable for you.

You will be asked to lie on your side while a small plastic tube (catheter) is passed into your rectum. This may feel a little uncomfortable, however it should not be painful. Once inserted, a small balloon may be inflated inside of you which will help keep the tube in place. The screening machine will then be brought over you; this is a machine which uses x-rays to allow the clinician to see the progress of the examination on a TV monitor. The barium (white fluid) is then run into your colon, which may make you feel full or want to open your bowels. We need your help here as you need to retain (keep) the barium in your colon. When enough barium has been introduced your colon will be inflated with a little air.

You are now ready for the x-rays to be taken. You will be asked to move into different positions as the pictures are taken. Colons can vary in length and some can have more loops in them. In these cases we may need more pictures and more turns by you, to allow us to image your whole colon.

Once the pictures have been taken satisfactorily, the radiographer will drain some of the barium and air. The tube will then be removed and you will be taken to a toilet where you can stay until you are feeling comfortable.

Will it be uncomfortable?

The barium enema should not cause you too much discomfort; if at any time it does you should tell the clinician. Some people do find the examination a little uncomfortable. The air, that is necessary for the examination, can make you feel bloated as though you have trapped wind.

How long will it take?

The procedure will normally take between 20 and 40 minutes depending on how difficult the individual colon is to image. We recommend that you allow two hours for your examination, as you will need to use the toilet afterwards.

Occasionally you may experience some discomfort at the end of the examination, until you can rid yourself of some air.

Are there any risks or complications?

An x-ray examination of the large bowel does carry certain risks.

• The duration and level of x-rays are kept to a minimum, but you do need to be exposed to x-rays for a total of two or three minutes. This means you are subjected to a quantity of radiation equivalent to the amount we all receive naturally from the atmosphere over a period of about three years.

• There is also a tiny risk of making a small hole (perforation) in your bowel. This happens very rarely and generally only if there is a problem like a severe inflammation of the bowel wall.

• There is also some slight risk if you are given an injection to relax your bowel. Please tell the radiographer if you have heart disease, glaucoma, or myastheania gravis.

Despite these risks, your doctor will have come to the conclusion that they recommend you should have this examination. Do remember that the risks from missing a serious disorder by not having the examination are considered to be much greater.

For patients of childbearing age

If there is any possibility you are pregnant, please contact the department for advice.

What if I have any further questions?

Hopefully this leaflet will answer a lot of your questions, but remember that you may ask the doctors looking after you about any of your tests or treatment. Or you can contact Radiology and speak to a barium radiographer or radiology nurse on telephone 01233 616033.

If you are diabetic and have concerns about fasting, please contact your GP or diabetic nurse.

References

This leaflet is produced with grateful acknowledgment to the Patient’s Liaison Group of the Royal College of Radiologists and East Kent Radiology Staff.