This special X-ray examination evaluates the colon or large bowel using barium sulphate liquid as contrast media. The colon is the portion of the intestine between the small bowel and the anus.

Since the advent of the colonoscope (endoscope of the colon), Barium Enema studies are less common. However, it still has a role to play if there is a change in bowel habits, passage of blood in the stools (faeces), unexplained abdominal/rectal pain, chronic constipation and as a complement to other investigations. Sometimes, when the colonoscope has been unable to assess the colon completely for various reasons (e.g. unusually “tortuous” route of the colon), the barium enema is done. There is also a significant cost difference, with the barium enema being more affordable. However, the advantage of a colonoscope is the ability to perform a biopsy (tissue sampling) should any abnormality be seen.

Sometimes, when there is marked narrowing of the colon or if there is cancer of the colon, a barium enema may be able to show the whole colon and the presence of multiple cancers better. The scope may have difficulty passing through the narrowed portion, while barium sulphate solution can trickle past the narrowing.

A detailed barium enema examination may reveal large bowel narrowing, ulceration, or lesions such as a polyp or a tumor.

1. Bowel preparation should be done 2 (two) days  or   (48hours) prior to the date of the procedure. 

2. Low fibre diet: Do not eat meat, vegetables, fruits, or milk products. Avoid high fibre foods.      

3. You can eat plain white bread, packet mee (such as Mamee, Maggie), fish and porridge on the 1^st(first) day of preparation.

4. On the 2^nd (second) day, only clear fluids, such as glucose, Ribena, Livita, plain water, chinese tea, coconut water, clear soup (strained chicken or meat soups) should be taken.

5. Throughout the 2 days, you must drink plenty of fluids, plain water included. This is because you will “lose” a lot of water when the medicine for clearing your bowel takes effect.

6. On the day or two before the procedure, you will probably be given some medication (laxatives and/or enemas) to help you pass motion. Do not be alarmed if you have diarrhoea, because this is the intended effect. This medication may come in the form of pills or fluid, such as Fleet Oral. Different radiology departments may give you a different type of medication for inducing bowel movement.

7. If your appointment is at 9 am in the morning, after 12 midnight on the day before the procedure, you will have to fast (no food or fluids) until the time of the procedure. If your mouth is very dry, suck an ice cube. If your appointment is not in the morning, you should fast at least 6 hours before the procedure.

What happens in a barium enema examination?

You will be asked some questions about previous bowel surgery, and what types of medication you are on, if any. If you think you may be pregnant, please inform the radiologist or radiographer attending to you.

You will be asked to change into a gown. A lubricated rectal tube is inserted a short distance into the rectum via the anal orifice. The barium is run in from an infusion bag. Gravity aids the flow of barium into the colon. The radiologist may give an injection into a hand vein to relax the bowels. However, this is not always necessary. Patients with irregular heart rhythms, acute urinary retention or glaucoma are to inform the radiologist so that an alternative drug may be given. The radiologist will guide the patient through the various imaging positions.

In a double contrast examination, the barium is allowed to drain from the colon (as much as is possible) leaving a coating of the barium on the inside surface of the colon (mucosal surface). After this, air (or carbon dioxide) is introduced carefully and under direct fluoroscopy (screening with X-rays) so that a relief of the inside lining of the colon is seen. This is necessary as in a collapsed and contracted state; it is difficult to see any abnormality of the colon. You will be asked to move into various positions on the x-ray table so that the different parts of the colon can be x-rayed. You will be expected to retain the barium and air until the examination is completed.

In some instances, depending on the patient’s condition, only the barium filled examination is done. Again, the examination is tailored to the patient’s condition and clinical diagnosis that is suspected.

Normally this examination will not take longer than an hour, and if the bowel is well prepared and there are no other factors, it may only take about half an hour.

The patient will be asked to go to the bathroom to pass out the barium and air and clean up if there has been any leakage around the anus onto the buttocks.

What are some of the potential complications?

This is a very safe examination.

In some patients who do not move their bowels daily, the small amount of barium that is left within the colon may “dry” out and constipation may occur. However, if the patient consumes plenty of fluids, vegetables and fruits, this rarely occurs and will be passed out with the normal bowel motion.

Another complication is the perforation of the large bowel with passage of barium (leak) outside of the bowel wall into the abdominal cavity. . As the examination is done under direct vision (fluoroscopy) of the radiologist, such a complication is extremely rare and would be treated immediately. A well-prepared bowel will ensure that minimal bowel contents will spill if there is ever a leak. 

There is a small amount of radiation involved in the examination. The potential benefits of this test far outweigh any risks.

What should I do after a barium enema examination?

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Last Updated:
Thursday, 21 August, 2003