16579 Contrast Enema For Children

Overview

A contrast enema is a test that uses X-rays to show the shape of your child’s large bowel. A special liquid that shows up on X-rays is gently passed into the bottom through a small soft tube. It is not usually a treatment. It helps the doctor look for reasons for problems such as ongoing constipation, tummy pain, or blood in stool. Your child’s healthcare team will explain why the test is needed and ask for your consent.

Yes. A contrast enema is a common test in children’s hospitals, especially when a child has long-lasting constipation or a suspected bowel problem.

It is mostly used for babies and young children, but it can be done at any age when a doctor needs a clear picture of the large bowel.

Symptoms

Common symptoms

• Long-lasting constipation or hard, painful poos
• Tummy pain or bloating
• Vomiting
• Blood in stool or in a nappy
• Poor feeding or poor weight gain in a baby
• Soiling or stool accidents after toilet training

Symptoms in children

• Crying a lot with tummy pain, especially in a baby
• Drawing up the legs and seeming very uncomfortable
• A swollen or tender tummy
• Not passing stool for several days with pain
• Pale, floppy, or more sleepy than usual
• Green or bloody vomit
• Blood in the nappy

Symptoms in older adults

• This article is about children. The same test is not usually used for older adults, who may have different bowel tests if needed.

Causes

Main causes

• The test is done to look for reasons for bowel symptoms, not because of one single cause.
• It may be used to check long-lasting constipation and how the large bowel is shaped.
• It may be used to look for Hirschsprung disease, a condition where some nerves are missing from part of the bowel.
• It may be used to check for intussusception, when one part of the bowel slides into another.
• It may be used to look at birth defects of the bowel or to follow up after bowel surgery.

Risk factors

• Long-term constipation or stool holding
• Being born with a bowel condition
• A family history of Hirschsprung disease
• Previous bowel surgery
• Being a baby or young child with feeding and stool problems

When to see a doctor

See a doctor urgently if:

• Your child has severe or worsening tummy pain
• Your child has green or bloody vomit
• Your child has blood in stool and looks unwell
• Your child is very sleepy, floppy, or hard to wake
• Your baby is feeding poorly, has fewer wet nappies, or seems dehydrated
• Your child has a fever after the procedure

Book a routine appointment if:

• Your child has ongoing constipation or painful poos
• Your child has soiling or stool accidents
• Your child is not growing or gaining weight as expected
• Your child needs follow-up after bowel surgery
• You have questions about the contrast enema or what happens afterwards

Diagnosis

A contrast enema is itself a test, not a diagnosis. The doctor uses it to get clear pictures of your child’s large bowel. Before the test, they will ask about symptoms, check your child’s tummy, and may do other tests first. The results are looked at together with your child’s history and examination.

Tests that may be done

• Abdominal X-ray
• Ultrasound scan of the tummy
• Contrast enema
• Blood tests
• Stool tests
• Rectal biopsy, a tiny tissue sample, if needed

What to expect at your appointment

Your child will usually lie on their side or back on an X-ray table. A small soft tube is put into the bottom and the contrast liquid is gently passed in. Your child may feel fullness, pressure, or the need to poo. X-ray pictures are taken, and the tube is then removed. The test often takes about 15 to 30 minutes, but allow extra time. Most children go home soon afterwards. The contrast leaves the body in stool over hours to a day or two.

Treatment

A contrast enema is mainly a way to find out what is happening, not a treatment. In one special case, intussusception, the pressure from the contrast can sometimes help push the bowel back into place, but this is done by specialist teams. If the test finds a problem, your child’s doctor will explain the options and next steps.

Self-care at home

• Follow any eating and drinking instructions given by your child’s team before the test.
• Bring comfort items, such as a favourite toy or blanket, to help your child feel calm.
• After the test, offer plenty of drinks and normal food unless told otherwise.
• The contrast may make stool look pale or chalky for a short time; this is expected.
• Call your child’s healthcare team if your child has fever, severe pain, bleeding, or swelling after the test.

Medical treatments

Treatment depends on what the test finds. It may include medicines to soften stool or treat infection, dietary changes, bowel training, or specialist bowel care. Your child’s doctor will discuss the best approach and get your consent before any treatment.

When is surgery considered?

Surgery is only needed if the test finds a problem that cannot be managed another way, such as a blocked or narrowed bowel or certain birth defects. The surgical team will explain the benefits and risks.

Living with this condition

Most children go home the same day and return to normal activities quickly. Your child may be a little tired or have some tummy fullness for a short time. Follow any advice from the radiology team and keep a note of when your child next passes stool.

Lifestyle tips

• Keep a simple diary of stool patterns and tummy symptoms if your child has ongoing problems.
• Encourage regular toilet time without pressure or punishment.
• Make sure your child has enough fluids each day.
• Ask your child’s team about school or nursery before the test if you need to plan ahead.

Diet and exercise

For constipation, a balanced diet with fibre, plenty of fluids, and regular physical activity can help. Fibre-rich foods include fruit, vegetables, beans, and whole grains. Changes should be gentle and suited to your child’s age. Ask your child’s healthcare team or a dietitian for advice if you are unsure.

Mental health and emotional wellbeing

Children may feel scared or embarrassed about a test near their bottom. Parents can feel anxious too. Explain in simple words what will happen, stay close if allowed, and praise your child afterwards. If anxiety is severe or ongoing, speak with your child’s healthcare team. If you or your child are in crisis or having thoughts of self-harm, contact your local emergency number or crisis service right away.

Prevention

You cannot always prevent the need for a contrast enema, because some bowel conditions are present from birth. But good bowel habits can reduce the chance of severe constipation. These include enough fluids, fibre, and activity, and gentle, regular toilet routines.

Vaccines

There is no vaccine for this test. Keep your child’s routine childhood vaccinations up to date as advised by your local health service.

Screening programmes

This test is not a routine screening test. It is done when symptoms or a known bowel condition need checking.

Complications

If left untreated

• Ongoing constipation can cause pain, poor appetite, and distress for the child and family.
• A blocked bowel can become an emergency if it is not checked and treated.
• Hirschsprung disease can cause severe constipation and serious infection if missed.
• Intussusception can damage the bowel if it is not treated quickly.
• Some birth defects of the bowel can cause poor growth or long-term bowel problems if not managed.

Long-term outlook

Most children cope well with a contrast enema, and the test gives the care team clear information. Many bowel problems in children can be treated effectively. Your child’s team will support you and explain the next steps in a calm, clear way.

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