Barium Enema


Last Updated December 20th, 2021

What is a barium enema?

A barium enema is a diagnostic test used to examine the large intestine for abnormalities. Basically, it is a radiographic (X-ray) examination of the large intestine-an organ which helps the body process waste. The areas viewed are right or ascending colon, the transverse colon, the left or descending colon, the sigmoid colon and the rectum. The appendix and a portion of the distal small intestine can also be included. The procedure is also called colon X-ray.

What is Barium?

Barium is an alkaline metal with atomic number 56 and the atomic symbol of Ba. Named after the Greek word ‘barys’ for heavy, it is found in nature only in combination with other elements. About 0.05 percent of Earth’s crust is barium. Barium isan ingredient in rodent poison and the weighing agents in oil drilling fluids. It is the white fluid used as a contrast medium to visualize the large intestine in a diagnostic process called barium enema.

Who should undergo a Barium enema test?

The procedure is undertaken in patients presenting with-

– Constipation and or change in bowel habits
– Weight loss (unexplained)
– Melaena (blood in stools)
– Chronic diarrhea
– Pain abdomen

A barium enema may detect the following lesions-

– Inflammatory bowel diseases which include Ulcerative colitis and Crohn’s disease
– Benign tumors including polyps
– Diverticula
– Strictures
– Hirschsprung disease
– Cancer

How to prepare for a Barium enema?

– You should discuss with your physician regarding medications that you might be taking and the indications for the same. The doctor needs to be informed if you suffer from any allergies.

– The physician delineates detailed instructions regarding the preparations needed to be undertaken before a barium enema is performed. He will also take you through the steps involved in the actual procedure.

– The doctor will advise you not to eat anything on the day before the procedure. The diet should include clear liquids including non-pulpy fruit juices, tea, coffee (black) and clear soup. Dairy products are to be avoided. The physician may also provide a laxative to be taken at night. Midnight onwards, you will be advised N.P.O (Nil per os/nothing by mouth). A self-administering enema may also be prescribed on the morning of the procedure.

– The whole idea is to keep the gastrointestinal (GI) tract empty to avoid any hampering of the visual field during the process of barium enema. Any formation of gases inside the intestines also leads to difficulty in visualizing the area of interest.

Is Barium enema safe for pregnant women?

A risk-benefit analysis needs to be done while performing any radiological procedure on a pregnant woman. X-ray exposure, especially when directed to the abdominal region, as is the case with Barium enema is a matter of major concern. However, research has so far proved that barium enema is not a teratogenic agent. However, a pregnant woman should share this vital information with the physician. It should also be noted if she has had exposure to radiation in the recent past. Ideally, pregnant women should avoid exposure to radiation as far as possible, especially when other diagnostic options are available.

Can infants and children undergo Barium enema?

Lower GI tract radiography can safely be performed on infants and young children. The procedure is similar to that used for the adults, so is the preparation. However, the parents may need to mentally prepare the child for the process.

What happens during a barium enema?

– You will be asked to remove all clothing, jewelry and any metallic objects that might interfere with the X-ray. A hospital gown will be provided, to be worn during the procedure.

– No sedation or anesthesia is required for barium enema and you will remain awake throughout the procedure. You will be asked to lie on your side on an examination table, as the X-ray technician takes a few X-rays to make sure that your colon is empty.

Barium enema consists of 2 stages-

– During the first stage, barium sulfate is instilled via the rectum to coat the inner walls of the large intestine. A well-lubricated enema tip is used for this purpose. This process is known as an enema. In some cases, air may be pumped into the colon in order to improve the resolution of the images. This is known as a double-contrast barium enema. The air also makes sure that the barium clings to walls of the intestine, coating the surface abnormalities completely.

– The second phase uses X-rays to produce an image of the lower GI tract. Several X-rays will be taken. Barium sulfate absorbs X-rays and appears white on the X-ray film, in contrast to the air and surrounding tissue that appear black.

– During the imaging procedure, you may be asked to move from side to side and hold a position for a given duration of time. This is done to enable barium to stick properly to the walls of the colon.

– The entire procedure takes about 20-30 minutes. A barium enema is usually carried out as a day-care procedure. You will be discharged the same day after a short period of recovery.

– It becomes essential to check with the insurance agency involved if it covers the cost of this procedure. Most of the insurance agencies are reluctant to cover the costs of a daycare procedure, more-so if it happens to be a diagnostic procedure.

What is the post-procedure care for a barium enema?

– You might experience slight cramping and discomfort in the abdomen. Taking deep breaths can alleviate this issue.

– It is also normal to feel the urge to defecate as a result of the enema that has been administered. However, you need to hold your stools until the procedure is complete. Overall, barium enema is associated with minimal pain.

– The physician will advise you to drink a copious amount of water for the next 24-hours and to inform him if you experience any discomfort.

– Your stools may appear white for a day as your body clears barium from its GI tract. Barium tends to cause constipation if it is not eliminated from the body. An enema may be prescribed if you have difficulty in passing flatus or stools for more than two days after the procedure.

What are the benefits and risks associated with barium enema?

Barium enema is a minimally invasive procedure and the complications including allergic reactions are rare. There is no risk of radiation remaining in the patient’s body after the procedure. The diagnostic range of X-rays used in barium enema is not harmful to the patient.

However, there is a slight risk of cancer from excessive exposure to radiation. In rare cases, barium leak may happen through an undetected hole in the GI tract. This can cause inflammation in the tissues involved. In severe cases, chemical peritonitis-an infection of the abdominal cavity can occur. Barium impaction may occur rarely, a result of barium causing an obstruction in the GI tract.

What are the important dos and don’ts I must follow before and after barium enema?

Take deep breaths during the procedure to alleviate any discomfort.Consume heavy food before the procedure.
Drink ample amount of water after the procedure is complete (for next 24 hours)Eat any form of dairy products before you undergo a barium enema.
Inform your doctor if you are pregnant before undergoing the procedure.Overlook symptoms of constipation, if they continue for more than 2 days.

How to understand a barium enema report?

A radiologist or a gastroenterologist will read the images and the findings will be communicated to your attending physician. If the results are abnormal, your doctor may advise you to go for additional diagnostic tests depending upon the irregularity encountered.

How is barium enema used as a therapeutic modality?

A barium enema is used to diagnose and treat intussusception. Both iodine and barium can be used as the contrast material. Intussusception is a serious disorder in which one part of the intestine slides into another part like a telescope. This leads to inflammation and subsequent obstruction. A therapeutic enema takes the help of air and contrast media to create pressure within the intestine and tries to ‘un-telescope’ the intestine.

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