Lower GI Series (Barium Enema)

A barium enema is a form of medical investigation that allows doctors to see clear images of the colon. X-rays usually pass straight through dense structures and it is therefore difficult for doctors to see clear images of the organs. Barium, a white liquid with moderate thickness, becomes apparent on X-rays and thus allows doctors to see the large bowel in detail.

A barium enema is the passing of barium into the bowel through the back passage. Barium can also enter the body as a drink to see the stomach, oesophagus and duodenum, which is called a barium meal or barium swallow. 

Why would I need a barium enema?

You may be advised to have a barium enema should you have symptoms such as constipation, diarrhoea or a family history of a bowel condition and your doctor suspects that you have:

• Bowel cancer.
• Polyps.
• Ulcerative colitis (this is when the lining of the large bowel becomes inflamed).
• Diverticular disease (this is when small pouches protrude from the intestine).
• Thinning of the colon.

Preparing for a barium enema

It is important that the bowel is empty before the test to ensure that the images are clear, so you are advised to avoid eating or drinking for a period of time before the test. You will also be given laxatives to clear the colon and you will be recommended to eat certain foods the day before. If you are taking any medication you should tell the radiographer. A barium enema is not usually advised for pregnant women because the radiation can cause harm to the unborn baby, so it is important that you tell the radiographer if you think you may be pregnant.

The radiographer will describe how the test works and they will be able to answer any questions you have. If you harbour any concerns before the day of the test do not hesitate to contact the hospital.

If you are diabetic you might be given special instructions to ensure that your blood sugar levels stay under control before and during the test.

How is a barium enema performed?

Before the test your clothing will need to be removed for you to get into a hospital gown. When you are ready you will need to lie down (usually on your front or side) on an X-ray table and the investigation will be given. The barium is given through an enema, a small tube, which is passed into the colon through the back passage. The liquid is then pushed into the colon and X-ray images will be taken. During the test the radiographer may also pump carbon dioxide into the bowel to make it easier to see, which may be a little uncomfortable but will not last long. In total the investigation usually takes around 15-20 minutes.

During the test the radiographer may ask you to manoeuvre into certain positions to enable doctors to see detailed images of your colon and you may also be given a muscle relaxant to encourage the muscles in the colon to relax. Once the radiographer is happy with the images the tube will be removed and you will be free to visit the lavatory, get changed and go home. If you have been given a muscle relaxant it is advisable to wait around 30-60 minutes before driving.

What happens after the test?

After the test you will probably need to visit the lavatory and once you get home it is a good idea to stay close to the toilet for a couple of hours, as the test may cause you to feel bloated and experience stomach cramps. Take it easy, take in plenty of fluids and try to eat high-fibre foods to keep your bowel moving and prevent constipation. It is normal for the barium to make the stools white or pale in colour for around 24 hours after the test.

Are there any risks?

A barium enema is considered a very safe procedure but there are risks, as with all procedures. In the vast majority of cases the benefits far outweigh the risks. During the test you will be exposed to radiation but the dose is small (equivalent to the amount you would be exposed to naturally over a 12 month period) and should not cause any harm. However, the test is not usually carried out on pregnant women as the radiation may cause harm to the unborn baby.

After the test you may feel a slight sickliness and have stomach cramps, but this should wear off quickly. Try to stick to a high-fibre diet and drink plenty of water to prevent constipation. If you had a muscle relaxant this may cause blurred vision for around an hour after the test.

There is a danger of perforation of the colon but this is very rare.