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Barium Enema

Brief Description – Barium enema is a special x-ray of the large intestine, which includes the colon and rectum. It is used much less often than in the past. Colonoscopy is done more often nowadays.

Why the Test is Performed

Barium enema is used to:

  •  Detect or screen for colon cancer
  •  Diagnose or monitor ulcerative colitis or Crohn’s disease
  •  Diagnose the cause of blood in stools, diarrhoea, or very hard stools (constipationHow the Test is Performed

    This test may be done in a doctor’s office or hospital radiology department. It is done after your colon is completely empty. Your doctor will give you instructions on how to empty your colon. You will lie flat on your back on an x-ray table. An x-ray will be taken. Then you will lie on your side. Your doctor will gently insert a well-lubricated tube (enema tube) into your rectum via your anus. The tube is connected to a bag that holds a liquid containing barium sulphate. This is a contrast material that highlights specific areas in the colon, creating a clear image.

    The barium will flow into your colon. X-rays will be taken a second time. A small balloon at the tip of the enema tube may be inflated to help keep the barium inside your colon. Your doctor will monitor the flow of the barium on an x-ray screen. Sometimes a small amount of air is delivered into the colon to expand it. This allows for even better images. This test is called a double contrast barium enema.

    You will be asked to move into different positions. The table is slightly tipped to get different views. At certain times when the x-ray pictures are taken, you will be told to hold your breath and be still for a few seconds so the images will not be blurry. The enema tube will be removed after the x-rays are taken. You will then be given a bedpan or helped to the toilet, so you can empty your bowels and remove as much of the barium as possible. Afterwards, one or two more x-rays may be taken.

    How to Prepare for the Test

    Your bowels need to be completely empty for the exam. If they are not empty, the test may miss a problem in your large intestine. You will likely be given instructions for cleansing your bowel. This is also called bowel preparation. Follow the instructions exactly. This ensures accurate results. Your bowels are emptied using an enema or laxatives. For 1 to 3 days before the test,

you need to be on a clear liquid diet. Examples of clear liquids are: clear coffee or tea, fat-free bouillon or broth, gelatin, sports drinks, strained fruit juices, water

During the Test

When barium enters your colon, you may feel like you need to have a bowel movement. You may also have a feeling of fullness, moderate to severe cramping and general discomfort. Taking long, deep breaths may help you relax during the procedure

After the Test

It is normal for the stools to be white for a few days after this test. You should try to drink extra fluids for 2 to 4 days. Ask your doctor about a laxative if you develop hard stools.


There is low radiation exposure. X-rays are monitored so that the smallest amount of radiation is used. Pregnant women and children are more sensitive to x-ray risks. A rare but serious risk is a hole made in the colon (perforated colon) when the enema tube is inserted.


This test aims to look for problems in the gullet (oesophagus). The problems that it can help find include:

  •  Narrowing (stricture)
  •  Hiatus hernias
  •  Tumours
  •  Reflux from the stomach
  •  Disorders of swallowing
  •  VaricesIn this test you drink some barium liquid. The barium liquid is often fruit-flavoured so it is pleasant to drink. You stand in front of an X-ray machine whilst X-ray pictures are taken as you swallow.

    You will usually be asked not to eat or drink for a few hours before this test. A barium swallow test takes about 10 minutes.


Brief Description

This is similar to a barium swallow except that it lasts longer and is used to assess structures beyond the oesophagus (specifically the stomach and duodenum). Barium X-ray tests are done less commonly these days. The more common test to look into the oesophagus, stomach and duodenum is with a flexible telescope (endoscopy). However, there is still a place for barium tests to help assess various problems of the gut.

Why the Test is Performed

It is used to find problems in the stomach and first part of the small intestine (duodenum) such as:

  •  Ulcers
  •  Zollinger Ellison’s syndrome
  •  Polyps
  •  TumoursHow the Test is Performed

    You drink some barium liquid, but you then lie on a couch whilst X-ray pictures are taken over your belly area. It may take a little longer to do than barium swallow. So that the barium coats all around the lining of the stomach, the doctor doing the test (radiologist) may do one or more of the following:

  •  Ask you to swallow some bicarbonate powder and citric acid before swallowing the barium. These ‘fizz up’ when they mix in the stomach and make some gas. The gas expands the stomach and duodenum and also pushes the barium to coat the lining of the stomach and duodenum. This makes the X-ray pictures much clearer. It is the shape and contours of the lining of the stomach and duodenum which need to be seen most clearly on the pictures
  •  Ask you to turn over on to your stomach on the couch. Various X-ray pictures may be taken whilst you are in different positions
  •  Give you an injection of a drug that makes the muscles in the stomach and gut relax How to Prepare For the TestYou will usually be asked not to eat anything for several hours before this test. (Food particles in the gut can make it difficult to interpret the X-rays.) However, you may be allowed sips of water up to two hours before the test. Tell your doctor if you have insulin-dependent diabetes, so that you can arrange for the best time for you to stop eating and for the test to be done. Discuss any other concerns or reservations with your doctor so that your mind will be at ease.

During the Test

The idea of drinking a chemical that is not edible could be frightening for a lot of people. However, it is perfectly safe and smells nice too. You may have to resist the urge to burp during the procedure so you don’t vomit.

After the Test

After you have had a barium X-ray test you should be able to go home as soon as the test is finished. Some people feel a little sickly for a few hours afterwards. You can eat normally straight after any barium test. The barium may make you constipated. Therefore, to help prevent constipation:

  •  Have lots of fluid to drink for a day or so to flush the barium out of your gut
  •  Eat plenty of fruit for a day or more
  •  See your doctor if you haven’t passed any stool after three or four daysThe barium will make your stool white or pale until it has all come out of your gut (after a day or more). If you had an injection to relax the muscles in your stomach, it may cause some blurring of your vision for an hour or more. If this happens it is best not to drive.


    The barium does not get absorbed into the body. Therefore, it is rare for a barium test to cause any complications or side-effects. Pregnant women, if possible, should not have an X-ray test, as there is a small risk that X-rays may harm the unborn child. Inform your doctor if you feel you may be pregnant.

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