A barium enema is a study of the large intestines, or colon, which comprises the final sections of the Gastrointestinal system. The colon itself is a large, tube shaped organ that is responsible for the final stage of digestion, including the final removal of any usable material (vitamins, minerals, proteins, water, etc.) and preparation of the waste material left over for delivery to the rectum for expulsion. The colon is generally divided into three sections, the ascending colon, which connects to the end of the small intestines and the appendix, the transverse colon, and the descending colon, which connects to the rectum via the sigmoid colon (so called because it resembles the letter S).

There are two types of Barium enemas that are commonly performed. A regular barium enema (also called a B.E.), and an air contrast B.E. (also called a B.E. with air or a double contrast B.E.). Both will demonstrate some of the same things, but a B.E. with air will show up the lining of the large intestine and some fine details better.

Since it is necessary for the large intestine to be as empty as possible for this exam, you will be instructed by your doctor to start preparing for it at lunch time of the day before. The biggest part of your preparation will be going on what is usually referred to as a "low residue" diet. This diet is designed to give you adequate nutrition while leaving very little waste to be expelled the next morning. You will also either be given, or instructed to obtain two or three different laxatives to help assure that the colon will be empty. One hospital I know even goes so far as to give the following instructions to any outpatients (patients who come into the hospital for only a few tests or procedures, and then go home the same day).

On the day before the examination do the following at the time indicated.

12:00 Lunch 1 cup of bouillon with 2-3 crackers

1 glass of apple or grape juice

1 serving of Plain jello -No Fruit Or Cream

1:00 p.m. Drink one large glass of water

3:00 p.m. Drink one large glass of water

5:00 Supper 1 cup of bouillon

1 glass of apple or grape juice

7:00 p.m. Drink one large glass of water

8:00 p.m. Drink one bottle of CITRATE OF MAGNESIA

10:00 p.m. Take the three (3) orange tablets with 1 large glass of water

12:00 Midnight If still awake, drink one large glass of water

7:00 a.m. Remove the foil from the suppository and insert it well up into

the rectum. Retain this as long as possible(at least 20 minutes)

for complete evacuation.

Needless to say, you can have nothing to eat after you get up in the morning until the examination is completed. You can however drink water, tea, or black coffee that morning since these liquids will be passed through the kidneys and not the large intestine.

When you report to the radiology department for your B.E., you will be instructed to remove all of your clothes and put on a hospital gown. The technologist will then escort you into the x-ray room where the exam will be done and explain the procedure to you to make sure you understand what you will experience. The technologist will then take one "scout" film of your abdomen, partly to be sure that he or she knows the proper settings to get the best possible pictures of you, and partly to allow the radiologist who will be overseeing your exam to be sure that there is nothing that could effect your exam in a negative way. Once the radiologist and the technologist have gotten everything ready, you will be asked to roll over onto your side, and an enema tip will be inserted into your rectum. Here in the South, most hospitals try to make sure that only men insert the enema tip in men, and only women insert the enema tip in women, but this does not always hold true through out the country. Please, if you feel concerned or embarrassed, do not hesitate to ask for a male or female technologist to insert the enema tip in you. We know that this is not exactly the most comforting of exams that we do, and we would prefer to do anything we can to keep you as comfortable as possible during the procedure.

Once the enema tip is in place, the radiologist will have the technologist start the enema flowing. The barium used in this test is a thick, white suspension that will show up on x-rays, and it may feel strange as it flows in. You might feel some minor cramping during this procedure as the barium flows backwards to the normal route foods and fluids would ordinarily follow in your colon. This is normal and if you take slow, deep breaths whenever you feel it, it should pass without problem. While the barium is flowing in, the radiologist will be watching it under flouroscopy, or flouro for short. Flouro is an x-ray technique similar to take a video, and the radiologist will use it to examine in detail any potential trouble spots he or she might find. Once the radiologist has examined you under flouro, and obtained any shots or pictures he or she may need, the technologist will take four to ten additional pictures using regular x-rays. The barium will then be drained out of you back into the enema bag, and you will be allowed to go to the bathroom to get rid of any barium you can that did not flow back into the bag for some reason. The technologist will then take one final picture to see just how effective your system is at expelling waste, and then he or she will show your completed films to the radiologist. If the radiologist does not see anything that requires additional films, you will then be allowed to leave.

One thing to be sure of following your exam, is to drink plenty of fluids the rest of the day. This will help you to get rid of any remaining barium, and some doctors will even prescribe a laxative to further assist you in expelling the last few traces of barium left behind. Generally, your exam will probably last about 30 minutes to an hour, so, unless something unexpected comes up, you probably will not lose the entire day.

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