A barium enema is a test that helps highlight the bowel, so it can be clearly seen on an X-ray. A white liquid is passed into your bowel through your bottom.
It allows doctors to investigate problems such as:
cancerous or non-cancerous growths (bowel polyps)
inflammation of the lining of the large bowel (ulcerative colitis or Crohn's disease)
pouches arising from the large intestine (diverticular disease)
When you may be referred for a barium enema
Your GP may suggest a barium enema if you have noticed blood in your stools or if you have an unexpected change to your bowel movements, such as diarrhoea or constipation.
It may also be used if you have a family history of colorectal polyps or colorectal cancer and you have unexplained lower abdominal pain.
A CT scan or a colonoscopy (a type of endoscopy) are alternatives to a barium enema.
A barium enema examination is not advisable if you are pregnant because you will be exposed to some radiation. The amount of radiation is considered safe for the patient but could be dangerous for an unborn child.
What happens during a barium enema
The examination will either be done by either:
a radiologist – a doctor with expertise in medical imaging
a radiographer – a healthcare professional specially trained to produce medical images
A liquid called barium sulphate is passed into your bowel through a small soft tube inserted into your bottom. The liquid coats the inside of your bowel so that it can be clearly seen on an X-ray.
At the same time, air is usually pumped through the tube to expand the large bowel. This helps to make the images as clear as possible.
The whole process of injecting the fluid and taking the required X-rays takes around 30 minutes. It should not be painful but can cause some discomfort and bloating, mainly due to the large bowel stretching when the air is pumped in.
You are usually given an injection of a medication called Buscopan during the examination. This can help relieve any cramping sensation and improve the pictures.
The X-ray images are analysed by a radiologist or radiographer after the appointment. A report is given to your doctor, usually within 14 days.
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How a barium enema is performed
A barium enema is a routine procedure that takes around 30 minutes to do. You should be able to go home shortly after the test.
You can take a family member or friend with you, but they may not be allowed into the X-ray room. It is advisable that you bring someone with you to drive you home, as you may not be able to drive straight after the procedure.
Preparing for a barium enema
Before having a barium enema, your bowel should be empty of any stools to make sure clear pictures can be taken. Your doctor will advise you about the type of food you can eat the day before the test and you will be prescribed a strong laxative to clear your bowel. Follow the instructions carefully and stay at home the day before your test to avoid any inconvenience and to be as comfortable as possible.
If you are diabetic and take insulin or tablets, make sure that you carefully follow any instructions given by the hospital so that your blood sugar levels do not drop.
If there are no special instructions on the information sheet you have recieved, contact the radiotherapy department and seek their advice before starting the bowel preparation routine. Most hospitals will try to arrange a morning appointment if you have diabetes.
During a barium enema
You will be asked to lie on an X-ray table on your side, and a small soft tube will be gently inserted a few centimetres into your bottom (rectum). You may also be given an injection, usually of Buscopan, a drug that helps prevent spasm of the colon. Many radiologists give this injection routinely at the start of each barium enema procedure. Your doctor may not give you this injection if you have a history of heart disease or glaucoma.
The barium sulphate liquid is passed through the tube and into your colon, and the radiologist or radiographer will be able to see this on a television screen. You may be asked to lie in a number of different positions to help the flow of the barium liquid, and to get it to spread evenly along the wall of the colon. Air may also be pumped into the colon to expand it and push the barium sulphate liquid inside. This may feel a bit uncomfortable, like having trapped wind.
After the barium has been passed into the colon, a number of X-ray pictures will be taken from various positions. The X-ray table will rotate to put you in a standing position. You will be asked to roll onto each side to obtain the various pictures required. As the X-rays are being taken, you will be asked to hold your breath.
The test usually takes about 30 minutes. When the X-rays have been taken, the tube will be removed and you can then go to the toilet.
The test results will be sent to your GP within 14 days.
Does it hurt?
Having a barium enema should not hurt but may cause some discomfort. Some people experience cramp-like pain during and a short while after the procedure.
The procedure does involve a significant amount of moving and rolling on the table. If you are weak or have a condition that may make this difficult, let the imaging department know before having the bowel preparation. An alternative test may be more appropriate.
Some people also worry that they may not be able to hold the barium liquid and air in their bowel. Try to hold on to it by keeping the muscles of your bottom very tight. If you let go too soon, it may affect the X-ray images.
Some people leak barium fluid onto the X-ray table, but try not to worry too much about this happening.
You can normally eat straight away after the procedure. It is a good idea to eat fruit and vegetables and drink plenty of fluids for three days afterwards to avoid constipation, until your stools have returned to normal. After the procedure:
You will need to go to the toilet. It's a good idea to stay close to a toilet for the next few hours.
Your stools will appear white and discoloured for a few days. This is the barium liquid passing out of your system.
If you have a Buscopan injection, you will need to wait up to 30 minutes before you drive as it can blur your vision. It is best to take someone with you to drive you home.
The radiology department
The radiology (X-ray or imaging) department is an area of a hospital where radiological examinations of patients are carried out, such as:
Radiologists are doctors who are specially trained to carry out examinations and interpret medical images, such as X-rays.
Radiologists are supported by radiographers, who are trained to carry out X-rays and other imaging procedures.
Risks during a barium enema
Before going ahead with a barium enema, your doctor and radiologist will weigh up any risks of the procedure against the benefits of diagnosing a potentially serious disorder or disease, such as bowel cancer.
There are some risks to consider before having a barium enema, although they are generally rare and it is usually a safe procedure. A barium enema may not be used in certain groups of people, such as pregnant women or people who have been diagnosed with severe colitis.
Exposure to radiation is low as the duration and level of radiation used is kept to a minimum. You will be exposed to X-rays for about two to three minutes. The quantity of radiation you are exposed to is equivalent to what you would receive naturally from the environment over about three years.
You should not have an X-ray if you are pregnant, as there is a slightly higher risk of an unborn baby being harmed by the radiation. A barium enema will only be used in very exceptional circumstances if you are pregnant.
There is a small risk of bowel perforation (a small hole in the bowel). This is a serious complication that can be fatal. However, it is extremely rare and generally only happens if you have a problem such as severe inflammation of the large bowel.
There is a risk of side effects from the drug Buscopan, which is given to relax the muscles of your bowel wall. Your radiologist will check whether you have a history of heart disease or glaucoma before giving the injection to you. The drug can cause temporarily blurred vision.
Some people may not tolerate barium very well and it may give them an upset stomach or constipation. In extremely rare cases, it may cause an allergic reaction.