A Barium enema

An Overview

A barium enema is an X-ray exam that can detect changes or abnormalities in the large intestine (colon). The procedure is also called a colon X-ray. An enema is the injection of a liquid into your rectum through a small tube. In this case, the liquid contains a metallic substance (barium) that coats the lining of the colon. Normally, an X-ray produces a poor image of soft tissues, but the barium coating results in a relatively clear silhouette of the colon.
Having a barium enema may be a bit embarrassing and unpleasant, but it shouldn’t be painful. You’ll probably feel uncomfortable when the air is pumped into your bowel during the test, similar to the feeling of having trapped wind. You may have some bloating, wind or stomach cramps for a short while afterwards.

Purpose of Test

A barium enema is an indirect form of visualization used to examine the anatomy of the colon and occasionally the terminal ileum (the junction between the small and large intestines).
It may be recommended by your doctor if you have:

• Chronic diarrhea
• Chronic constipation
• Rectal bleeding
• Unexplained abdominal pain
• Unexplained weight loss
• Unexplained changes in bowel habits
• Bowel obstruction, such as caused by adhesions (scarring), volvulus (twisting), or intussusception (the telescoping of the intestine into itself)
• Celiac disease, an immune reaction to gluten resulting in the flattening of the intestinal lining
• Colon polyps, fleshy growths in the colon that have the potential to turn cancerous
• Colorectal cancer, cancer of the colon and/or rectum
• Diverticular disease (including diverticulosis and diverticulitis), in which abnormal pockets form in the intestine
• Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. A barium enema is a test that helps to highlight the large bowel so it can be clearly seen on an X-ray.
During the test, a white liquid called barium is passed into your bowel through your bottom.
A barium enema may be requested by any doctor who thinks you might have a problem with your bowel, including your GP.
The test will usually be carried out at a hospital radiology department by a radiologist or radiographer.

Why it’s done

In the past, doctors used barium enema to investigate the cause of abdominal symptoms. But this test has mostly been replaced by newer imaging tests that are more accurate, such as CT scans.
In the past, your doctor may have recommended a barium enema to determine the cause of signs and symptoms, such as the following:
• Abdominal pain
• Rectal bleeding
• Changes in bowel habits
• Unexplained weight loss
• Chronic diarrhea
• Persistent constipation

Risks

A barium enema exam poses few risks. Rarely, complications of a barium enema exam may include:
• Inflammation in tissues surrounding the colon
• Obstruction in the gastrointestinal tract
• Tear in the colon wall
• Allergic reaction to barium

Having a barium enema

Barium enema exams generally aren’t done during pregnancy because X-rays present a risk to the developing fetus

During the test:

• you’ll be asked to lie on your side on an X-ray table, and an injection of a medication called Buscopan may be given into your arm or hand to prevent involuntary bowel movements
• a small, soft tube will be gently inserted a few centimetres into your bottom, where it will remain throughout the test
• the barium is passed through the tube and into your bowel – try to keep the muscles in your bottom tight to prevent it coming back out, but don’t worry if some leaks out
• you may be asked to move around a bit to help the barium spread along your bowel, and air may be pumped into your bowel to expand it and help push the barium around
• several X-rays will be taken with you in different positions

Bowel Preparation

In order to obtain accurate images of your colon, you will need to completely empty your bowel of any fecal matter. This requires a restricted diet, laxatives, and possibly an enema. This is referred to asbowel preparation.

Once the appointment is scheduled, you will be given written instructions outlining what you can eat and how to vacate your bowel.
• 24 hours before the test, you will restrict yourself to a clear liquid diet. This includes the avoidance of milk or cream.
• At around midday, you will take a laxative at the time and dosage prescribed by your doctor. You will need to stay home and close to a bathroom, as the laxative will trigger frequent and watery bowel movements.
• For the rest of the day, you will need to drink plenty of fluids to keep hydrated. You may also want to apply some petroleum jelly to your anus after each bowel movement to avoid chafing.
• At bedtime, you may need to take another dose of the same or a different laxative. Some labs recommend this two-part procedure; others don’t

Managing Side Effects

• Your stools may appear white for a day or two as your body gradually clears the barium from the bowel. Some people may also experience constipation, headache, upset stomach and diarrhea. These symptoms tend to be mild and resolve within a couple of days.
• To lessen these side effects, drink plenty of fluids and eat foods high in insoluble fiber. Saline cathartics (like Milk of Magnesia (magnesium hydroxide)) can gently treat stomach upset and constipation, while emollient cathartics (like mineral oil or glycerin suppositories) may ease bowel movements.

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