What happens during a double contrast barium enema?

• Overview
• Test Details
• Results and Follow-Up

Overview

What is a barium enema?

A barium enema is a special type of X-ray healthcare providers use to take images of your large intestine. It’s also called:

• Colon X-ray.
• Lower gastrointestinal (GI) tract radiography.
• Lower GI exam.
• Lower GI X-ray.

What is a barium enema used for?

A barium enema can help identify changes or problems in your large intestine, which includes your colon, rectum and anus. For example, the test can help diagnose or assess:

• Colonic volvulus (twisting of the large intestine).
• Colorectal cancer or colon polyps.
• Diverticulosis or diverticulitis (bulges in the wall of the colon).
• Inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease.
• Large bowel obstruction.

A healthcare provider may order a barium enema if you have certain symptoms, such as:

• Abdominal pain.
• Blood in your stool (poop).
• Changes in bowel habits.
• Constipation.
• Diarrhea.
• Unexplained weight loss.

Colonoscopy is also used for many of those conditions. Your healthcare provider will determine which test is right for you.

Who performs lower GI X-rays?

A radiology technician or radiologist usually performs this procedure. They are specialists in medical imaging.

Test Details

How does the test work?

Radiography uses radiation to create images of the tissues, organs, bones and vessels inside your body. A barium enema uses a special type of X-ray called fluoroscopy. Barium is a contrast medium, a substance that improves the visibility of internal structures during radiography.

The white, chalky barium liquid coats the inner lining of your large intestine. Then the X-ray machine can take pictures of the substance. That helps healthcare providers see your large intestine’s shape, lining and size.

What can I expect before a barium enema?

Your healthcare provider will give you specific instructions to follow before the test. They may include:

• Avoid solid foods and dairy.
• Consume only clear fluids (for example, broth, water and popsicles).
• Skip certain medications for a few hours or days before the test.
• Take laxatives to empty the bowels of any waste. Common laxatives include magnesium citrate, bisacodyl tablets or bisacodyl suppositories.

What can I expect on the day of the lower GI exam?

A barium enema usually takes 30 minutes to an hour.

For the test, your healthcare provider will:

1. Ask you to remove your clothing and jewelry and give you a hospital gown to wear.
2. Tell you to lie on your side on an exam table under an X-ray machine.
3. Take X-rays to make sure your bowels are empty.
4. Insert a lubricated tube into your anus, then inject the barium liquid through that tube into your intestine.
5. Possibly add some air through the tube, which is called a double-contrast barium enema.
6. Take several images of your large intestine.
7. Ask you to adjust your position or hold your breath, then take additional pictures.

Is a barium enema test painful?

You shouldn’t have any pain during a barium enema, but you may feel:

• Cramps.
• Discomfort.
• Fullness or bloating.
• Pressure.
• Urge to poop.

Take deep breaths to help yourself relax. Resist the urge to poop until the healthcare provider says you can go to the bathroom.

What to expect after the test?

When your healthcare provider has all the necessary images, they’ll remove the tube and allow you to go to the bathroom.

Over the next few days, drink plenty of fluids and eat foods that contain a lot of fiber. Examples include whole grains, vegetables and fruits. This will help flush out the barium and regulate your bowel movements. Your healthcare provider also may recommend that you take a laxative.

Your stool might be white, gray or light brown for a few days. This is normal — it’s the barium leaving your body.

What are the risks of this test?

Barium enemas are generally safe, but rare complications can occur, such as:

• Allergic reaction to barium.
• Perforation (tear) in your colon lining.
• Severe constipation (impaction) or obstruction from barium that hardens.

Barium is not radioactive, but X-rays give off a small amount of radiation.

Results and Follow-Up

When should I know the results of the test?

A radiologist will examine the images and write a report for the healthcare provider who ordered the test. That provider will schedule a follow-up appointment or call you. That’s when you will get the results and next steps. It might take a day to several days.

When should I call my doctor?

After a barium enema, seek medical attention immediately if you experience any signs of complications:

• Abdominal distention (swelling).
• Dizziness or weakness.
• Fever.
• Inability to poop or pass gas within two days.
• Rectal bleeding (blood in your poop).
• Severe abdominal pain.

A note from Cleveland Clinic

A barium enema is a special type of X-ray that takes images of your large intestine, which includes your colon, rectum and anus. Your healthcare provider may order this test if you have unexplained gastrointestinal symptoms or suspected disease in your large intestine.

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Last reviewed by a Cleveland Clinic medical professional on 06/15/2022.

References

• American Society of Clinical Oncology. Barium Enema. (https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/barium-enema) Accessed 6/15/2022.
• American Society of Radiologic Technologists. Barium enema examination. (https://www.asrt.org/docs/default-source/patientpages/barenema_papg.pdf) Accessed 6/15/2022.
• Radiological Society of North America. Lower GI X-ray. (https://www.radiologyinfo.org/en/info/lowergi) Accessed 6/15/2022.

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