What Is a Barium Enema? - Preparation, Procedure & Side Effects

Instructor: Marisela Duque

Marisela teaches nursing courses at the college level. She also works as a unit educator, teaching experienced nurses about changes in nursing practice.

Barium enemas are used to diagnose problems in the large intestine or colon. In this lesson, you will learn how a barium enema is done, the preparation techniques and potential side effects, then test your knowledge with a quiz.

Dan's Story

Dan is a hardworking emergency room (ER) nurse. He loves the thrill of the ER and not knowing what will happen next. But recently Dan has dreaded going into work. This is because his bowel habits are out of control. Sometimes he feels like he can't get his work done between trips to the bathroom with diarrhea, not to mention that he always cringes when someone is waiting to use the restroom behind him. After two weeks of this, he was feeling very week. Finally, Dan visited the ER, only this time as a patient. The doctor ordered a number of tests to see what was causing the problem. One such diagnostic test is a barium enema.

What is a Barium Enema?

A barium enema is a special x-ray of the large intestine (colon). An enema is a procedure in which a liquid is inserted into the rectum, and barium is the liquid used in this particular procedure. It works by making the colon appear clearly on an x-ray, which is one of the oldest diagnostic medical tools still in use - it uses a small amount of radiation to take pictures of the body's insides. These two procedures together are used in a barium enema to clearly visualize the colon and detect any changes or abnormalities.

This test may be ordered if you are suffering from certain gastrointestinal problems, such as unexplained weight loss, rectal bleeding, persistent constipation or, in Dan's case, chronic diarrhea. This test also allows healthcare providers to diagnose inflammatory bowel disease or growths such as tumors or benign polyps.


Since Dan's healthcare provider is going to be taking a close-up look of his colon, it is important that he empty it completely before the procedure. Preparation for a barium enema involves several steps that will clean the colon up so that the images appear clear. These steps include:

  • Following a special diet for 1-3 days before the test: This includes eating only clear liquids like gelatin, sports drinks, water, black coffee, broth, and water.
  • Fasting after midnight: Dan will not be allowed to eat or drink anything after midnight the day of the procedure.
  • Taking a laxative: A laxative is a medication that comes in pill or liquid form. This medicine will make Dan go to the bathroom so that his colon will be empty for the test, and it is usually prescribed the evening before the test.
  • Managing medications: Dan should be sure to ask his doctor about his regular medications. Depending on his medical condition and which medications he takes, Dan's doctor may give him special instructions. For instance, he may have to wait until after the procedure to take his daily dose of a particular drug.

How is the Procedure Done?

The whole procedure takes about 30-60 minutes to complete. First, Dan will be asked to change into a hospital gown and remove any jewelry. Then he will be asked to lie on his side on a special x-ray table for the exam. A doctor that is specially trained in diagnostic imagining (called a radiologist) will be the person performing the test.

After Dan takes his place on the table, a few x-rays may be taken to be sure that his colon is completely clear. Then, a small plastic tube is inserted into the rectum (not to worry it is heavily lubricated). The tube is connected to a bag that holds the enema solution (barium sulfate). The barium then flows from the bag into the colon while x-rays are taken. Sometimes a little bit of air is also administered into the rectum to get a better view - this is called a double contrast barium enema.

An enema bag

Dan may feel a little cramping or the urge to use the bathroom during the procedure, but taking deep breaths may help. A small plastic balloon on the edge of the enema tube will hold all the barium inside the body to ensure accurate images. Sometimes the patient is asked to move into different positions while the enema coats the colon and x-rays are taken. Other times, the special table the patient is on will be tipped into different positions.

Once the test is complete, Dan will be able to use the bathroom. It is important that he expel as much of the barium as possible at this time. The radiologist will read the x-rays and send the results to the doctor.

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