Barium Enema

Information for Adult Patients

What is a barium enema?

A barium enema is a special X-ray study of the large bowel (colon and rectum). On an ordinary X-ray of the abdomen, details of the image of the large bowel are very poor. To improve the image, barium is used as a contrast medium to line the bowel and this shows up white on X-rays. During the examination, air can be put into the bowel to distend it, and this combined process is sufficient to diagnose minor degrees of inflammation or small tumours and tiny polyps.

Both the barium and the air need to be passed into the bowel through a small, soft tube, which is inserted into the rectum, or back passage.

Are there any risks?

An X-ray examination of the large bowel does carry certain risks. The duration and level of X-rays are kept to a minimum, but you do need to be exposed to X-rays for a total of 2 or 3 minutes. This means you are subjected to a quantity of radiation equivalent to the amount we all receive naturally from the environment over a period of about 3 years.

There is also a tiny risk of making a small hole in the bowel, a perforation. This happens very, very rarely indeed, and generally only if there is problem like a severe inflammation of the bowel wall.

There is also some slight risk if you are given an injection of the drug 'Buscopan' to relax the muscles in the wall of the bowel, and make the examination less uncomfortable (see above). The radiologist or specially trained radiographer will ask you if you have any history of heart disease or glaucoma before giving this injection. The drug may, rarely, cause blurring of vision for a short period. You should obviously check that your vision is clear before driving.

Despite these risks, your doctor will have come to the conclusion that they recommend you should have this examination, and do remember that the risks from missing a serious disorder by not having it, are considered to be much greater.

Are you required to make any special preparations?

Yes, this is most important. It is essential that your bowel should be empty, and a leaflet accompanying your appointment will explain what you should eat and how you need to take the special laxative provided. This laxative is vigorous and to avoid inconvenience it is best to stay at home on the day before the examination.

If you are diabetic

If you take insulin or tablets you need to make sure you have enough to eat on the day before your appointment to prevent low blood sugars and you should follow the advice given by the Radiology Department ( in the special accompanying leaflet).

If you are pregnant

This examination is not advisable for pregnant women, unless there are exceptional circumstances. Please advise the Department if you think you are, or might be, pregnant.

May you bring a relative / friend?

Yes, but for reasons of safety, they may not be able to accompany you into the X-ray room except in very special circumstances.

When you arrive

Please report to the reception desk in the Radiology Department. Once you have checked in, you will be shown to where you will be collected by the radiographer.

Within the Department the lavatories and public telephones are signposted clearly should you need them.

Upon collection

You will be shown to a private cubicle where you may undress and remove jewellery and watches etc. If you are diabetic you must inform the radiographer, as also must all women who are pregnant or believe they might be so

You will be asked to put on the surgical gown and dressing gown provided. However, you may prefer to bring your own dressing gown if you wish. You will be asked to place your clothes and personal items in a basket, which you keep with you.

Whom will you see?

You will be cared for by a small team including a radiographer, and usually a radiologist. Whoever is doing the examination will be watching a television screen during the procedure and taking separate X-rays. Later a radiologist will review the X-ray images and issue a report.

What happens during the barium enema investigation?

You will be taken into the special X-ray room and asked to take off your dressing gown, but will still wear the surgical gown. You will be asked to lie down on the X-ray table, on your left side at first. The radiologist or radiographer will insert the soft plastic tube into your rectum (back passage), and the barium liquid then flows through the tube and around your bowel. The radiologist or radiographer watches this on the television screen and moves you into different positions, both to help the barium flow and to better see other parts of the bowel. Once sufficient barium is in the bowel, a quantity of air is also introduced through the same tube, and this both expands the bowel further and increases the contrast to make the detail more clear.

At this point, several X-rays will be taken with you in different positions, some probably with you standing up, and some with you lying on your side.

You may be given an injection, generally of Buscopan, to relax the muscles of the bowel wall, and make the examination easier. Some radiologists and most radiographers will give this routinely at the start of the procedure, unless you have a history of heart disease or glaucoma. Other radiologists may not give it unless they see a lot of bowel spasm on the television monitor. This injection may cause some blurring of vision, and you would be advised not to drive for an hour or so afterwards.

Once the radiographer or radiologist is satisfied that sufficient X-rays have been taken of the large bowel, the tube will be removed, and you will be allowed to leave the X-ray room and go to the lavatory. Afterwards, you may require a further X-ray, but this is just an ordinary X-ray, with no need for further tubes!

Will it be uncomfortable?

This examination should not hurt a lot, although occasionally a patient may feel a cramp-like pain which may persist for a while afterwards. However, during the examination you might feel the slight discomfort associated with the bowel becoming full.

Some patients are obviously worried about being unable to hold on to the barium, and making a mess on the X-ray table. It is obviously important to try and hold on to the barium and air by keeping the muscles of your bottom very tight. It is possible that not enough information will be obtained if you do release the barium on the table. However, it is accepted that this can sometimes happen so try not to worry too much.

How long will it take?

The whole process of taking the images will take about 15 minutes. Unless you are delayed by having to wait such as for emergency patients, your total time in the Department should be about 1 hour.

Are there any side effects?

You will want to visit the lavatory immediately after the examination, and it is advisable to remain within reach of the lavatory for the next few hours. Your stools will appear white and may remain discoloured for the next day or two.

If you have had an injection of Buscopan, then you should probably wait for up to an hour before you drive home. It may be best to have a friend drive you. Some people are happy to go on to work afterwards, but most prefer to have several hours at home, recovering before resuming normal activities.

Can you eat and drink afterwards?

Yes, do so normally, especially drinking plenty of fluids for at least 3 days to prevent being constipated.

When will you get the results?

After the procedure, the images will be examined further by the radiologist, who will then issue a report on the findings. This may take some days to reach your referring doctor but this is normally less than a week. You could ask the radiographer or radiologist for some indication of timing.

If you have a query?

If you have a query about having the barium enema, please ring the Radiology Department between 9am and 5pm, Monday to Friday.

Adapted from a document compiled by the Royal College of Radiologists