17961 Barium Enema

Overview

A barium enema is a test that uses X-rays to take pictures of your large bowel (the colon and rectum — the lower part of your digestive system). A soft white liquid called barium is gently run into your back passage through a thin tube. Barium shows up clearly on X-rays, so it coats the inside of your bowel and lets your doctor see its shape, outline and any narrow or unusual areas. It is sometimes called a 'lower gastrointestinal series' or a 'contrast enema'. It is not a treatment, and it is not a diagnosis on its own — it is a way of looking inside. Today, other tests such as colonoscopy (a camera test) or CT colonography (a special scan) are used more often, but a barium enema is still useful in some situations.

Barium enemas used to be very common, but they are done less often now because camera tests and CT scans give more detail and allow samples to be taken at the same time. Many hospitals still use them for particular situations, so it is not an unusual test.

Anyone can be offered a barium enema if their doctor needs a closer look at the large bowel. It is most often used in adults who have symptoms such as blood in the stool or a change in bowel habit, or who need a known bowel condition checked. It is only occasionally used in children, and then for specific reasons a specialist team will explain.

Symptoms

Common symptoms

• This test is not caused by symptoms — it is used to investigate them. Symptoms that may lead to a barium enema include blood or mucus in your stool.
• A lasting change in bowel habit, such as looser stools or constipation that does not settle.
• Tummy pain, cramping or bloating that keeps coming back.
• Feeling that you have not fully emptied your bowel.
• Unexplained weight loss or tiredness linked to low iron levels (anaemia), which your doctor may want to check.

Symptoms in children

• A barium enema is only rarely used in children, usually under the care of a children's specialist team.
• It may be considered for certain bowel problems present from birth or for a bowel blockage that comes and goes.
• Children's hospitals use smaller tubes and gentler settings, and a parent or carer can usually stay close by.

Symptoms in older adults

• Older adults are more likely to be offered this test because bowel symptoms and bowel polyps (small growths) become more common with age.
• You may be asked about other health conditions, such as heart or kidney problems, before the test.
• If you have trouble with your mobility or memory, tell the team in advance so they can make the appointment easier for you.
• Bowel-clearing medicine can cause dehydration, so older adults may need extra advice about drinking fluids.

Causes

Main causes

• A barium enema is a test, not a condition, so it does not have 'causes' in the usual sense. Doctors request it to look for reasons behind symptoms or to check a known problem.
• Reasons it may be requested include investigating blood in the stool or a change in bowel habit.
• Checking the extent and pattern of inflammation in long-term inflammatory bowel conditions.
• Looking for polyps (small growths on the bowel lining) or narrowed areas of the bowel.
• Checking how the bowel is healing or working after bowel surgery, or helping plan an operation.
• Sometimes it is used when a camera test is not possible or not suitable for you.

Risk factors

• Being older, since bowel problems and polyps become more common with age.
• A family history of bowel conditions or bowel cancer.
• Long-standing inflammatory bowel disease.
• Previous bowel surgery or a known structural bowel problem.
• Having another health condition that makes a camera test harder, such as a very narrowed bowel or frailty.

When to see a doctor

See a doctor urgently if:

• Severe tummy pain, a swollen hard tummy, or a high temperature after the test.
• Heavy bleeding from your back passage.
• Being unable to pass stool or wind, with pain and bloating.
• Signs of dehydration after bowel preparation, such as dizziness, dark urine or passing very little urine.
• Any symptom that feels suddenly much worse than expected.

Book a routine appointment if:

• You have not received your results within the time you were told to expect them.
• You are still constipated or uncomfortable more than a few days afterwards.
• You have questions about what the test involved or what the findings mean.
• You feel anxious or confused about the next step in your care.

Diagnosis

There is nothing to 'diagnose' about the test itself — the barium enema is the test. Your doctor decides whether to request it based on your symptoms, your medical history and any earlier tests. A specially trained doctor or radiographer (an imaging specialist) carries out the test and a radiologist (a doctor who reads X-rays) studies the pictures and writes a report. You will usually be told how and when to expect the results, and you may need a follow-up appointment to discuss them.

Tests that may be done

• Barium enema itself: X-ray pictures taken while barium, and sometimes a small amount of air, fills the large bowel.
• Blood tests, including a full blood count to check for anaemia.
• Stool tests to look for infection or hidden blood.
• Colonoscopy or flexible sigmoidoscopy — camera tests that can also take samples.
• CT colonography — a scan-based look at the bowel, often used instead of a barium enema.
• A follow-up appointment or clinic review to go through the findings.

What to expect at your appointment

You will usually be asked to follow a special diet and take bowel-clearing medicine for a day or so before the test, so your bowel is empty. On the day, you will change into a gown and lie on your side on an X-ray table. A thin, soft tube is gently put into your back passage and the barium liquid flows in. You may be asked to turn over a few times, and X-rays are taken. Some people have a little air passed in too, which helps the pictures show up better. You may feel cramping or a strong urge to go to the toilet — this is expected and passes. Afterwards you can use the toilet, and you will be given a pad in case any liquid leaks. You can usually go home straight away, but it is a good idea to have someone with you or arrange a lift if you feel shaken. Drink plenty of fluids afterwards.

Treatment

A barium enema does not treat anything — it gives your doctor information. What happens next depends entirely on what the pictures show. Many people have normal results and need no further action. Others may need a follow-up test or a discussion about managing a bowel condition. Your healthcare team will explain your results in plain language and talk through your options with you.

Self-care at home

• Follow the preparation instructions exactly — the test works best when your bowel is clean and empty.
• Drink plenty of water in the day before and after the test, unless your team has told you to limit fluids for another reason.
• Eat lightly after the test and gradually return to your normal diet.
• Drink extra fluids for a few days afterwards to help pass the barium and avoid constipation.
• Use the toilet whenever you feel the urge, and expect pale or chalky stools for a few days.
• Ask your pharmacist for advice if you become constipated — do not start any new medicine without checking, especially if you take other regular medicines.
• Keep a note of any symptoms afterwards and who to contact if you are worried.

Medical treatments

Any treatment is for whatever the test finds, not for the test itself. If the pictures are clear, no treatment is needed. If a bowel condition is found, your doctor will explain the general options, which may include dietary changes, medicines prescribed by your own clinician, or monitoring with repeat tests. If a polyp or narrowed area is seen, you may be offered a camera test to look more closely and, if needed, take a sample. Your team will always discuss the choices with you before anything is decided.

When is surgery considered?

Surgery is only relevant if the test reveals a problem that needs an operation, such as a narrowed or blocked section of bowel, a growth that cannot be treated another way, or part of a long-term bowel condition that is not responding to other care. This is not common after a barium enema, and any decision about surgery would be made with a specialist team after further tests and a full discussion with you.

Living with this condition

For most people the barium enema is a single appointment that is soon over. You can usually return to normal activities the same day, though you may prefer a quiet evening. Your stools may look pale for a few days — this is the barium leaving your body. Waiting for results can feel unsettling, so it can help to plan something distracting and to note down any questions you want to ask at your follow-up.

Lifestyle tips

• Keep drinking water regularly for the next few days.
• Stay gently active — a short walk can help your bowels get back to normal.
• Return to your usual diet as soon as you feel ready, adding fibre gradually.
• Avoid alcohol heavily or long periods without fluids in the first day or two.
• Note any new or worsening symptoms so you can describe them clearly if you need to call for advice.

Diet and exercise

After the test, eat and drink normally as soon as you feel able. A balanced diet with fibre from fruit, vegetables and wholegrains, plus plenty of fluids, helps keep the bowel working well. Gentle movement such as walking supports digestion. If a bowel condition is found, your team may suggest specific dietary changes — ask for advice tailored to you rather than making big changes on your own.

Mental health and emotional wellbeing

Tests that look for bowel problems can bring worry, embarrassment or fear, especially while you wait for results. Feeling anxious is completely understandable. It can help to talk to someone you trust, write down your questions, and ask your healthcare team to explain anything that is unclear. If worry is affecting your sleep, mood or daily life, tell your doctor — support is available and you do not have to manage alone. If you ever feel you cannot cope, contact your local crisis or mental health support service, or your local emergency number if you feel unsafe.

Prevention

A barium enema is a test, so it cannot be prevented — and you would not want to. What you can do is prepare well so the test is as clear and comfortable as possible, and look after your general bowel health. Eating a balanced diet with fibre, drinking enough fluids, staying active and not smoking are all good for your bowel. If you have ongoing bowel symptoms, getting them checked early is the most useful step you can take.

Screening programmes

Many countries, including the UK, run bowel cancer screening programmes for people in a certain age range, usually using a simple stool test posted to your home, with a camera test offered if needed. Screening aims to find problems early, before symptoms appear. Ask your doctor or pharmacist about the screening programme where you live and whether you are due to take part.

Complications

If left untreated

• The test itself does not need treating, but symptoms that are not investigated can sometimes mean a bowel problem is found later than it could be.
• Ongoing bleeding or a change in bowel habit may point to conditions that are easier to manage when found early.
• Rarely, the test can cause a small tear in the bowel wall, heavy bleeding or a reaction to the barium — the team watches for these and will tell you what to look out for.
• Constipation after the test is fairly common and can usually be eased with fluids and advice from your pharmacist.

Long-term outlook

For most people a barium enema is a straightforward, safe test that gives useful answers and is over quickly. Serious complications are uncommon, and the team carrying out your test is trained to keep you comfortable and to spot problems early. Whatever your results show, there is usually a clear next step, and your healthcare team will support you through it.

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