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Barium Enema

Last updated Feb. 5, 2019

Approved by: Krish Tangella MD, MBA, FCAP

Image showing Double contrast barium enema.


Background Information:

What are the other Names for the Procedure?

  • Colon X-ray
  • Lower Gastrointestinal Examination using Barium Enema
  • Lower GI Exam using Barium Enema

What is Barium Enema radiology procedure? (General Explanation)

  • Barium Enema is an examination of the large intestine (colon). The exam is used to help diagnose diseases and other problems that affect the large intestine. The procedure is also known as Lower Gastrointestinal Examination (using Barium Enema)
  • It includes examination of the ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and the appendix
  • To make the intestine visible on an X-ray image, the colon is filled with a contrast material containing barium

What part of the Body does the Procedure involve?

A Barium Enema procedure involves the colon (large intestine) and rectum.

Why is the Barium Enema radiology procedure Performed?

  • A Barium Enema procedure is useful in diagnosing tumors, cancers, and other illnesses, related to the intestine
  • It is also performed to determine the treatments in case of symptoms, such as abdominal pain, weight loss, constipation, bloody stool, chronic diarrhea, irritation in bowel, and change in bowel movements

What is the Equipment used? (Description of Equipment)

The equipment used for a Barium Enema procedure could include the following:

  • An examination table
  • X-ray tube
  • A computer monitor
  • An image intensifier (that converts x-rays into video images)

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Barium Enema procedure (for examination of lower gastrointestinal tract). 

What is the Cost of performing the Barium Enema radiology procedure?

The cost of a Barium Enema procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities. 

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding a Barium Enema procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently 

What are some Helpful Resources?

http://www.dana-farber.org/Health-Library/Barium-enema--What-to-expect.aspx (accessed on 08/02/2014)

http://www.chp.edu/CHP/barium+enema (accessed on 08/02/2014)

Prior to Barium Enema radiology procedure:

How does the Barium Enema radiology procedure work?

  • X-rays are passed through the patient’s body and the image is recorded on a recording plate
  • In a fluoroscopy, the contrast material used in the procedure helps the radiologist to visualize the colon

How is the Barium Enema radiology procedure Performed?

A Lower GI Exam using Barium Enema procedure is performed in the following manner:

  • An X-ray is taken to check, if the bowel is clean
  • A rectal exam is performed
  • Barium and water is sent into the colon through a small tube, inserted into the rectum
  • Air may be injected to help barium coat the lining of colon completely
  • X-ray images are then taken

Where is the Procedure Performed?

The Barium Enema procedure is performed as an outpatient procedure, at a hospital. 

Who Performs the Procedure?

A radiologist performs the Barium Enema examination.

How long will the Procedure take?

  • A single contrast study usually takes about 30-45 minutes, though the actual time barium is held inside the body is only for 10-15 minutes
  • The double-contrast or air-contrast study may take up to an hour to complete

Who interprets the Result?

A radiologist interprets the results obtained from the Barium Enema examination.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Barium Enema procedure:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
  • It is highly recommended to inform your healthcare professional, if you are pregnant or breastfeeding
  • Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations, before the preparation sessions
  • The patient will be asked to be on a clear liquid diet for 1-3 days, before the test
  • The patient will then be asked to take a combination of laxatives to empty their stomach

What is the Consent Process before the Procedure?

A physician will request your consent for a Barium Enema procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Barium Enema procedure:

  • The X-ray used in the procedure generally does not have any side effects
  • The procedure often provides enough information to diagnose the condition; due to which more complicated procedures, such as a colonoscopy, can be avoided
  • As barium used in the procedure does not get into the blood stream; having an allergic reaction due to barium is very rare
  • Mostly, barium does not have any complication associated with its usage for this procedure

Following are the risks of the Barium Enema procedure:

  • Since radiation is used in the procedure, there is a very slight risk of cancer
  • Very rarely, the barium used in the procedure may cause barium impaction (obstruction in the gastrointestinal tract)
  • Very rarely, barium leakage from the lower GI tract may cause allergic reactions

What are the Limitations of the Barium Enema radiology procedure?

The Barium Enema procedure cannot be used for patients with severe abdominal pain, or in patients with a recent history of colonic biopsy.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is a Barium Enema procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Barium Enema radiology procedure:

What is to be expected during the Barium Enema radiology procedure?

The following may be expected during the Barium Enema procedure:

  • There may be slight discomfort or cramping, due to the barium in the colon
  • The patient may be asked to change their positions, so as to obtain better images
  • The insertion and subsequent removal of the enema tip may cause some discomfort
  • The patient shall be given an enema to expel the barium, after the examination
  • A visit to the restroom may be required to expel the remaining barium

What kind of Anesthesia is given, during the Procedure?

A Barium Enema procedure typically does not require the use of anesthesia. 

How much Blood will you lose, during the Procedure?

Generally, there is no rectal bleeding observed, during the Barium Enema study.

What are the possible Risks and Complications during the Barium Enema radiology procedure?

There are not very many risks and complications of a Barium Enema radiology procedure. However, in rare cases, complications of this exam may include:

  • Inflammation of the tissues surrounding the colon
  • Gastrointestinal obstruction
  • Gastrointestinal perforation (tear in the colon wall)
  • Allergic reaction to barium

Barium Enema is not usually performed during pregnancy. This is because X-rays present a risk to the developing fetus.

What Post-Operative Care is needed at the Healthcare Facility after the Barium Enema radiology procedure?

Generally, no significant post-operative care is needed at the healthcare facility, after a Barium Enema procedure.

After the Barium Enema radiology procedure:

What is to be expected after the Barium Enema radiology procedure?

The following may be expected after the Barium Enema procedure:

  • The patient may return to normal diet and regular activities, right after the examination
  • The patient may experience constipation; their stools may appear white for a day, due to the barium
  • It is advisable to inform the physician, if no bowel movement is experienced for more than 2 days, after the examination

When do you need to call your Physician?

Patients should contact the physician immediately after the Barium Enema procedure, if they:

  • Experience any rectal bleeding
  • Have severe abdominal pain
  • Develop a fever
  • Do not have a bowl movement, many days after the lower GI examination

What Post-Operative Care is needed at Home after the Barium Enema radiology procedure?

The following post-operative care is necessary at home after the Barium Enema procedure:

  • The patient may need to take some rest for 1-2 days, since they may feel tired, after the examination
  • It is advisable not to drive for a few days after the procedure

How long does it normally take to fully recover, from the Procedure?

A Barium Enema exam can be exhausting and make the patient feel fatigued for 1-2 days, after the exam.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

There is no tissue extracted from the patient during a Barium Enema procedure. 

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Barium Enema radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Interventional radiologist, performing the procedure
  • Healthcare providers, physicians, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Barium Enema procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 16, 2014
Last updated: Feb. 5, 2019