Barium Enema

What you should know

• Barium enema, also called BE, is an x-ray procedure to examine the lower gastrointestinal tract (GIT) using barium. Liquid barium is a white, chalky contrast material that helps the colon show up better on the x-ray. Barium enema is used to help diagnose diseases and other problems that affect the lower GIT. These may include abdominal (stomach) pain, bleeding, blockage, cancer (tumor), polyps (growths), or diverticuli (pouches in the intestinal wall). The lower GIT is made up of the colon (large bowel) and rectum (rear end). The colon is the long tube that connects the small bowel with the anus (opening through which stool passes). The colon absorbs water from digested foods and turns the digested food into stool. It stores the stool until it passes out through your anus.
  
  
• A barium enema may be done on an out-patient basis or during a hospital stay. Barium enemas may use a single contrast (barium only) or double contrast (barium and air). Barium is put in through a tube that is inserted into your rectum. The colon may also be filled with air to distend (expand) it and give better images. With a barium enema, conditions of the lower GIT may be diagnosed, and proper treatment may be given.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• Barium enema is a common and safe procedure. Sometimes, the procedure may cause unpleasant side effects. You may have bleeding, an abnormal heartbeat, or cramping abdominal (stomach) pain. Your colon may get perforated (torn) due to increased pressure while the barium and air are passing through. This may cause bowel contents to leak out of the colon into the abdomen. The barium may harden if it not cleared out of your colon after the procedure. This may lead to a partial or complete blockage of your colon. Following your caregiver's advice after the procedure may decrease your chance of having any problems.
  
  
• Without this procedure, your exact disease may not be diagnosed and proper treatment may not be given. The signs and symptoms you have may continue and worsen. You may have problems eating, digesting food, or moving your bowel that may lead to other serious medical problems. Ask your caregiver if you are worried or have questions about your procedure, medicine, or care.

Getting Ready

The week before your procedure:

• Ask a family member or friend to drive you home after your procedure. Try not to drive yourself home.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• A contrast material will be used during your procedure to help caregivers see the colon and rectum better. People who are allergic to dyes, iodine, or shellfish (lobster, crab, or shrimp) may also be allergic to barium. Tell your caregiver if you have allergies to any food, medicines, latex, or contrast material.
  
  
• Tell your caregiver if you have had a barium enema, barium swallow (upper GI tests), or other similar procedures before and when they were done.
  
  
• Tell your caregiver if you are pregnant or have other diseases. These diseases may include diabetes (high blood sugar level), inflammatory bowel disease (IBD), diverticulitis, or kidney problems. Certain medicines used in emptying your bowel may not be good for your condition.
  
  
• You may need to have blood, urine, or stool tests to check how well your body is working. Ask your caregiver for more information about these tests.Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The day before your procedure:

• Directions for eating and drinking:
  
  
  • A clear liquid diet or a diet that helps clean your colon may be started. Clear liquids may include plain gelatin, unsweetened fruit juices, clear soup, or broth.
    
    
  • Avoid eating or drinking foods with sugar or dairy products, such as milk, cream, or cheese.
    
    
  • Do not eat foods with residue or fiber that are not easy to digest. These include fruits, vegetables, cereal, nuts, peas, beans, fried foods, and bread.
    
    
  • Increase the amount of water you are drinking. Make sure you drink 8 to 10 (eight ounce) cups of liquid on this day.
  
  
• Your bowel needs to be empty before your procedure. This will help the x-rays show better pictures of the inside of your colon. Your caregiver may tell you to take a cathartic (laxative). These medicines may give you diarrhea (loose, watery stools), but will quickly clean out your bowel. Ask your caregiver for more information about these medicines.

The night before your procedure:

• Ask caregivers about directions for eating and drinking.
  
  
• Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.

The day of your procedure:

• Write down the correct date, time, and location of your surgery.
  
  
• Do not eat or drink anything on the morning of your procedure. The pictures may not be seen clearly if your stomach is not empty. You may also need another enema, using warm water, the morning of your procedure.
  
  
• Ask your caregiver before taking any medicine on the day of your procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• If you are staying in the hospital after your procedure, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Wear loose fitting, comfortable clothes. Avoid wearing girdles, pantyhose, or tight-fitting clothes. You will be asked to put on a hospital gown before the procedure.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You will be taken on a stretcher to the radiation (x-ray) room and then moved onto a special bed or table. Your caregiver may give you glucagon or an anti-spasmodic (prevents spasms) medicine that will help your colon relax. You will be asked to lie on your left side. Your caregiver may use a finger to perform a digital rectal exam (DRE) to check your rectum. X-ray pictures will be taken before filling your colon with barium. Your caregiver will watch the whole procedure on a small video screen.
  
  
• During a single contrast barium enema, a soft tube with lubricant (jelly) will be gently placed into your rectum. The barium is then passed through the tube and into the colon. A small balloon on the tip of the tube may be inflated to help hold the barium in your colon. The passage of the tube and barium may cause a feeling of pressure and a little discomfort. You may have an urge to have a bowel movement (BM). Remember to take small, deep breaths through your mouth, and try to hold everything inside your colon. Pictures will be taken as the bed or table moves and as you change positions. You may be asked to lie on your back, abdomen (stomach), and then on your left side.
  
  
• If a double contrast barium enema will be done, the barium will be drained out of the rectum. Your caregiver will then put air or carbon dioxide (gas) into the tube to help expand (distend) your colon. Pictures will be taken to see how the air or gas moves inside your colon. When the procedure is finished, the tube will be removed. You may then go to the bathroom and get rid of whatever barium is left inside your colon. Additional pictures may be taken after you have passed out as much barium as possible.

After your procedure:

You may go back to the bathroom to pass the remaining barium and air left in your rectum. You may also lie in bed and rest for a while since the procedure may be tiring. When your caregiver sees that you are OK, you may be allowed to go home. If your caregiver wants you to stay in the hospital, you will be taken back to your hospital room. Ask your caregiver for information on how to take care of yourself after your procedure.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have constipation (dry, hard stools) and the medicines are not helping to empty your bowel.
  
  
• You have questions or concerns about your procedure.

Seek Care Immediately if

• You are not able to eat or drink, or are urinating less or not at all.
  
  
• You have blood in your bowel movement (BM).
  
  
• Your abdomen becomes tender and hard.
  
  
• Your signs and symptoms are getting worse.
  
  
• Your vomit (throw up) has blood or bile in it.