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Barium Enema - Procedure, Benefits, Risks, and Results

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A barium enema is an X-ray examination that detects changes or abnormalities in the large intestine (colon). This article gives a detailed view of barium enema.

Written by

Dr. P. Saranya

Medically reviewed by

Dr. Isaac Gana

Published At November 7, 2022
Reviewed AtMarch 8, 2023

Introduction:

A barium enema is an x-ray examination of the lower gastrointestinal tract. The large intestine, including the rectum, is visible on the x-ray film by filling the colon with a liquid called barium sulfate. Barium coats the lining of the colon to get a clear picture. The procedure is also called colon x-ray.

Why Is Barium Used With X-Rays?

Barium sulfate is a dry, white, chalky powder mixed with water to make a barium solution. Barium is an x-ray absorber and looks white on x-ray film. When given through the rectum, barium coats the large intestine wall. This allows for better visualization of the lining, size, shape, and contour of the colon. Barium is used only for diagnostic studies of the gastrointestinal tract.

Why Is Barium Enema Done?

A barium enema is used to detect the signs and symptoms such as:

A barium enema is also used to detect conditions such as:

  • Polyps as a part of colorectal cancer screening.

  • Inflammatory bowel diseases like ulcerative colitis and Crohn's disease.

  • Irritable bowel syndrome.

How to Prepare for the Procedure?

Before a barium enema exam, it is necessary to empty the colon. Any residue left in the colon can obscure the x-ray images.

To empty the colon, the following are done:

  • Special Diet the Day Before Exam: The patient is asked not to eat anything the day before the exam. Drink only clear liquids like water, tea, or coffee without milk or cream and clear carbonated beverages.

  • Fast After Midnight: The patient is advised not to eat or drink anything after midnight before the exam.

  • Take a Laxative: Take a laxative the night before the exam. The laxative is taken in a pill or liquid form. This will help to empty the colon.

  • Use an Enema Kit: An enema kit is used the night before the exam or a few hours before the exam to empty the colon.

  • Medications: Inform the doctor about the medications you are taking a week before the exam.

What Happens During the Procedure?

The patient is asked to remove eyewear, jewelry, or dental devices before the exam. The patient wears a surgical gown during the procedure. The patient remains awake throughout the barium enema procedure. The patient lies on the side of an examination table.

A lubricated enema tube is inserted into the rectum. A barium bag is connected to the tube to deliver barium solution into the colon. Air is blown through the same tube into the rectum. Air will appear as black on x-ray film, contrasting the barium's white color. The use of two substances, barium, and air, is called a double contrast study. The tube that delivers barium has a small balloon on its tip. This balloon helps in keeping the barium inside the body.

The benefit of this technique is that it shows smaller surface abnormalities of the large intestine. When the colon is filled with barium, the patient feels the urge to have a bowel movement. Mild abdominal cramping is also present. Take deep long breaths for relaxation. The patient is asked to change positions and sometimes to hold their breath. This ensures that the entire colon is coated with barium. Many x-rays are taken from various angles. A barium enema exam takes about 30 to 60 minutes.

What Happens After the Procedure?

After the procedure, the barium is removed from the colon using the enema tube. The patient is asked to use the toilet to expel additional barium and air. The patient may have white stools for a few days as the body expels the remaining barium. Barium may cause constipation sometimes, so the patient is advised to drink more fluids and eat foods high in fiber following the exam. The patient can resume the normal diet and activities after the barium enema.

What Are the Results?

The result can be positive or negative.

  • Negative Result: A barium enema exam is considered negative when there are no abnormalities in the colon.

  • Positive Result: A barium enema exam is considered positive if the radiologist detects abnormalities in the colon. In case of a positive result, the doctor recommends some other tests like a colonoscopy.

What Are the Benefits of Barium Enema?

  • It is a minimally invasive procedure with rare complications.

  • This can provide enough information to avoid more invasive procedures like colonoscopy.

  • Because barium is not absorbed in the blood, allergic reactions are rare.

  • The X-ray range used in this diagnostic procedure is less and has no side effects.

What Are the Risks of Barium Enema?

Some rare complications of barium enema include:

  • Inflammation of the tissues surrounding the colon.

  • Tear in the wall of the colon.

  • Allergic reaction to barium.

  • Obstruction in the gastrointestinal tract.

  • Constipation can occur if barium is not completely eliminated from the body.

  • Barium enema exams are contraindicated during pregnancy because x-rays risk the developing fetus.

What Are the Contraindications for a Barium Enema?

Contraindications for barium enema include:

  • Suspected bowel perforation.

  • Pregnancy.

  • Severe ulcerative Colitis.

  • Toxic megacolon.

  • Acute abdominal pain.

Certain factors or conditions that interfere with the accuracy of barium enema include:

  • Recent barium swallow.

  • Stool in the bowel.

  • Colon spasm.

Barium Swallow vs. Barium Enema:

In barium swallow or barium meal, the barium sulfate powder is mixed with water and then swallowed. X-rays are taken when swallowing the mixture.

In barium enema, the powder is mixed with water and inserted into the rectum through a tube into the large intestine, and x-rays are taken.

Conclusion:

A barium enema is a radiographic examination of the lower gastrointestinal tract and is often less expensive than a colonoscopy. Having barium enema can be a bit embarrassing and unpleasant but not painful.

Frequently Asked Questions

1.

What Is the Purpose of a Barium Enema?

An X-ray examination known as a barium enema can reveal changes or abnormalities in the colon (large intestine). The procedure is also known as an X-ray of the colon. The process of injecting a liquid into the rectum through a small tube is known as an enema.

2.

How Much Does Barium Enema Hurt?

Although it may be embarrassing and unpleasant, a barium enema should not be painful. During the test, the pressure of the air pumped into the bowel will probably make people feel uneasy, similar to trapped wind. Afterward, people might experience bloating, wind, or stomach cramps for a short time.

3.

How Is the Barium Enema Prepped?

People will start the exam lying on their side on a table made just for it. In order to ensure that their colon is clean, an X-ray will be taken. Afterward, an enema tube with grease will be inserted into the rectum. Next, the barium solution will be delivered into the colon through a barium bag attached to the tube.

4.

Do People Awake During Barium Enema?

Throughout the barium enema procedure, people will remain awake. A plastic tube will introduce the contrast material, barium, into the rectum. In addition to that unpleasant sensation, people may also feel the liquid's pressure. Otherwise, there should be little pain.

5.

After a Barium Enema, How Long Do People Poop?

As the body naturally removes any barium still in the colon, people may experience white stools for a few days. In addition, because barium can cause constipation, drinking more fluids in the days after the exam can lower the risk of getting it. If necessary, the physician may prescribe a laxative.

6.

Is the Barium Enema Superior to the Colonoscopy?

Endoscopy and barium enema have been directly compared in detecting adenomas and carcinomas in two recent studies with different designs (endoscopy 1995;27:159-163, gastroenterology 1997;112:17-23). Both demonstrated that barium enema was inferior to endoscopic examination in detecting colorectal neoplasia.

7.

Are CT Scans Superior to Barium Enemas?

CT scans and barium enemas are both imaging techniques used to evaluate the gastrointestinal tract, but they have different advantages and applications. The researchers demonstrated that a CT scan was superior to a barium enema in detecting precancerous polyps and bowel cancer. 

8.

What Is the Most Prevalent Side Effect of a Barium Enema?

Most of the time, barium enema is considered a safe test. However, the most common serious complication is bowel perforation, which occurs between 0.004 and 0.04 percent of cases.

9.

Can People Eat After Having Barium Enema?

After the exam, the enema tube will remove most of the barium from the colon. People can use the toilet to eliminate more barium and air when the tube is taken out. People should be able to resume their usual diet and activities right away after any abdominal cramping usually subsides quickly.

10.

What Should People Avoid Doing Before Swallowing Barium?

Before the swallowing test, people must stop eating and drinking for about eight hours. In most cases, this indicates after midnight. Before scheduling a barium swallow test, one should tell the healthcare provider if they are pregnant or think one might be pregnant.

11.

After a Barium Enema, What Foods Can Be Eaten?

After a barium enema, it is generally recommended to start with a light diet and gradually progress to normal eating habits. People might be told not to eat and to only drink clear liquids like broth, clear carbonated beverages, tea or coffee without milk or cream, and water. 

12.

Is a Barium Enema Help in the Diagnosis of Polyps?

A barium enema can detect abnormalities of the large intestine, such as tumors, inflammation, polyps (growths), diverticula (pouches), obstructions, and changes in the structure of the intestinal tract. The radiologist may also inject air into the large intestine after injecting barium into the rectum.

13.

Can Diverticulitis Be Detected by Barium Enema?

When a patient is suspected of having diverticulitis, barium enema imaging has traditionally been the primary examination method. This is because diverticula, the colonic mucosa and lumen, spasm, and muscle hypertrophy are superbly depicted in barium studies.
Dr. Isaac Gana
Dr. Isaac Gana

Cardiology

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