What is a barium enema?

A barium enema is an X-ray procedure that examines your colon. The colon, also called the large intestine, is a long, hollow organ in your abdomen. It removes water from digested material and forms feces. A barium enema helps diagnose intestinal symptoms, such as changes in bowel movements, abdominal pain, or rectal bleeding.

A barium enema is also called a lower GI (gastrointestinal tract) series or lower GI tract radiography. It makes still pictures as well as moving images. It uses a special type of X-ray called fluoroscopy. 

The procedure involves putting barium inside the colon through a tube inserted into the rectum. Barium is a chalky metallic contrast material. It illuminates the colon to show detailed images of the inside of the colon. 

A barium enema is only one method used to diagnose colon conditions.  You may have less invasive testing options. Consider getting a second opinion about all of your testing choices before having a barium enema.

Why is a barium enema performed? 

Your doctor may recommend a barium enema is to diagnose diseases and conditions of the colon and rectum including:

  • Abdominal pain, if the underlying cause has not been found through other, less invasive tests. Abdominal pain can be caused by many conditions from inflammatory bowel disease to intestinal ulcer.
  • Abnormal changes in your bowel movements, such as chronic constipation or diarrhea
  • Anemia (low red blood cell count), if the underlying cause has not been found through less invasive testing. A barium enema can identify masses or growths in the colon which can cause bleeding.
  • Bleeding symptoms, such as rectal bleeding, bloody stool, or black, tarry feces. Potential causes of such bleeding include colon cancer and intestinal inflammation or damage.
  • Colon cancer. A barium enema can identify abnormal growths, polyps, and masses in the intestines.
  • Colon polyps, abnormal growths in the large intestine that can become cancerous
  • Diverticulosis and diverticulitis, intestinal pockets that can develop over time and become infected
  • Inflammatory bowel disease, which includes ulcerative colitis and Crohn's disease
  • Irritable bowel syndrome (IBS). A barium enema may be used to rule out other causes of IBS symptoms, such as a blockage in your intestines.
  • Unexplained weight loss, if the underlying cause has not been found through less invasive testing

Who performs a barium enema?

A radiologist and a radiologist technician perform a barium enema. A radiologist, also called a diagnostic radiologist, is a doctor who specializes in diagnosing and treating diseases and injuries using medical imaging techniques. A radiologic technologist is a medical professional who specializes in medical imaging and the care of patients during imaging procedures.

How is a barium enema performed?

Your barium enemas will be performed in a hospital radiology department, outpatient setting, or doctor’s office. Your barium enema will take about an hour. It generally includes these steps:

  1. You will dress in a patient gown and lie on an examination table.
  2. The radiologic technologist will position you on the table. The technologist will take a preliminary X-ray to make sure the colon is cleaned out well enough to take good pictures. 
  3. The radiologic technologist will instill the barium mixture slowly into the colon. The barium flows through a small, lubricated enema tube inserted into the rectum. A small amount of air may be injected to help the barium spread more evenly in the colon. This makes the best images.
  4. The radiologic technologist will take a series of painless X-ray pictures. You will be repositioned as needed to get pictures of different areas of the colon.
  5. After all the X-rays have been taken, you will wait briefly while the pictures are checked for quality.
  6. The radiologic technologist takes more pictures as needed. 
  7. Most of the barium will flow out of the colon through the enema tube before it is gently removed. 

Will I feel pain?

Your comfort and relaxation is important to you and your care team. You may feel fullness, mild pressure, or brief, minimal cramping during the procedure. You may also feel like you need to have a bowel movement. Take a few long, deep breaths to help yourself relax. Tell your care team if any discomfort does not pass quickly.