Barium Enema

What is a barium enema?

A barium enema is an imaging test that uses X-rays to take images of your large intestine—or colon. The test uses a contrast solution containing barium, which is delivered into your colon using a tube inserted in the rectum called an enema.

X-ray imaging alone doesn’t give your care team a good view of the colon. The barium contrast solution coats the inside of your colon, providing a clearer picture of its silhouette. It allows your team to get real-time images as the barium solution flows through your colon, an imaging technique known as fluoroscopy.

Your team can examine these images for any changes in your colon that might be a sign of a digestive condition.

doctor discussing a barium enema with a patient

Why might I need a barium enema?

Barium enemas aren’t used as often today because there are other more effective options. You might need a barium enema to look for signs of a digestive condition if you have symptoms or if you can’t have a more commonly used digestive test—like a colonoscopy.

The images from a barium enema might help find digestive diseases such as:

Colorectal cancer or polyps
Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
Diverticulitis
Irritable bowel syndrome
Bowel obstruction
Twisting of the colon

Barium enema vs colonoscopy

Barium enemas are no longer recommended by the U.S. Preventive Services Task Force as a first-line test for colon cancer screening and have largely been replaced by colonoscopy. The main reason is that colonoscopy is a better test to detect digestive problems, allows for biopsies and can remove polyps at the time of the procedure.

While both a barium enema and a colonoscopy can detect signs of digestive conditions, a barium enema is a less sensitive test and can miss small polyps and minor problems. If an issue is discovered on a barium enema, you will likely need a colonoscopy to get samples or remove polyps.

Barium enema is a less invasive test that isn’t usually performed under anesthesia like a colonoscopy. Another non-invasive option that does not require anesthesia is a virtual colonoscopy (also known as a CT colonography). However, all of these tests do require prep ahead of time to clean out the colon.

Barium enema prep

The prep for a barium enema is similar to the prep for a colonoscopy. You’ll need to take medications the evening before to ensure your colon is empty, allowing your team to get accurate images during the test. It’s important to follow your prep instructions carefully and completely.

Your doctor will give you step-by-step instructions for your specific test, but most people can expect to:

Stop taking certain medications or supplements, such as blood thinners, non-steroidal anti-inflammatory drugs or iron, in the week before your test.
The day before your barium enema, follow a clear liquid diet. This means you’ll only be allowed to drink liquids such as black coffee or tea, water, clear soda or broth.
Take laxative medications the night before your test that will make you go to the bathroom often to clean out your colon.
Use an enema or suppository to help clear out any remaining residue from your colon.
Avoid eating or drinking anything after midnight.

The barium enema procedure

You’ll have your barium enema procedure in a special imaging room with the tools needed to perform a fluoroscopic X-ray. The barium solution will be delivered using an enema. The procedure takes about 30 to 60 minutes, but plan to be at the facility for a little over an hour to allow time for check-in, prep and a brief period of monitoring following your test.

Understanding the results

After reviewing the images, a radiologist will provide a report with the results of your test. Your doctor will let you know the results and answer any questions about your next steps.

Results

Depending on the quality of the images, you may need other tests to give your care team more information.

Negative result: A negative result means the radiologist didn’t find any abnormal areas in your colon on the images.
Positive result: A positive barium enema result means something abnormal was found on your images. Your doctor might recommend follow-up tests, like a colonoscopy, to take samples and diagnose the cause.