What You Need To Know About Barium Enemas

This Test Might Be Used To Test For Several Different Digestive Conditions

Barium Enema
A barium enema is one test that might be done to determine where a fistula is located and find out more information about it. Image © A.D.A.M.

What Is A Barium Enema?

A barium enema (also called a lower gastrointestinal series) is a special type of X-ray that uses barium sulfate and air to outline the lining of the rectum and colon. Barium sulfate is a chalky chemical that shows up as white on X-ray film. The barium is given in an enema which is then 'held' inside the colon while X-rays are taken.

Intestinal abnormalities may appear as dark silhouettes or patterns along the intestinal lining on the X-ray.

Air may be pumped into the colon to help sharpen the outline of the intestinal wall.

A barium enema can be performed as an outpatient procedure, and usually takes about 45 minutes. The enema might be uncomfortable, but the X-rays are completely painless.

What It's Used For

A barium enema is used to check for polyps (abnormal growths on the intestinal lining), diverticulosis, tumors, or other abnormalities. Beginning at age 50, a barium enema may be recommended once every 5 to 10 years instead of a colonoscopy. People who are at a higher risk of colorectal cancer because of previous colorectal cancer, ulcerative colitis, history of intestinal polyps, or a family history of colorectal cancer should get tested earlier than 50 years of age.

The Preparation

Your doctor will give specific instructions on how to prepare for this test. An empty colon is necessary to give the best X-ray results. Your doctor will give directions on using enemas or laxatives before the test, as well as instructions on when to fast or only drink liquids.

How It's Done

After checking in at the hospital, you will be instructed to dress in a hospital gown and asked to lie on your side. You will be given an enema of barium fluid through a tube inserted into your rectum. You may feel 'full,' or that you need to empty your bowels. You will be instructed to 'hold' the fluid inside while a technician will take a series of X-rays.

You may be asked to change positions on the table, so that the barium will flow into different parts of the bowel and give better images.

After this series of X-rays, you will be allowed to get up and go into a restroom to pass the barium fluid. Next, a second series of X-rays will be taken, this time while air is gently pumped into your rectum. The thin film of barium still in your intestine and the air will enhance the pictures of the lining of your intestine.

The Risks

There is a risk of intestinal blockage from the barium fluid if it is not cleared from your bowel. This can be prevented by carefully following your doctor's instructions to clean your bowel of barium after the procedure. A barium enema is a safe procedure.


The X-rays will be looked at by a radiologist who will communicate results to your doctor. Before you leave from the test, you should be given instructions on when you can expect your doctor to have the results.

Your doctor will give additional instructions about how to clear the barium from your system.

These instructions may include drinking water, using an enema, or taking laxatives. Your stools may be a lighter color for a few days while the barium clears.

When You Should Call The Doctor

Call the doctor if you notice:

  • abdominal or rectal pain
  • blood in your stool
  • nausea
  • stools do not return to a normal color
  • trouble moving bowels
  • very narrow (as thin as a pencil) stools
  • vomiting blood

Keep In Mind

Before the barium enema, a digital rectal exam should be performed to make sure there are no rectal problems that would interfere with the procedure.

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