For patient safety, patients exceeding the weight limit of 325 lbs. will not be done at London X-Ray Associates.

1. Overview

   The barium enema is an x-ray examination of the large bowel (colon). Passing small, highly controlled amounts of radiation through the body and capturing the resulting shadows on film creates x-ray images. Most people are familiar with plain x-rays which produce a still picture of the body. A similar imaging method, fluoroscopy, uses x-rays to capture a moving image of an organ. Both still x-ray images and fluoroscopy are usually used during a barium enema. The inside of the colon is coated with a liquid (barium) which blocks x-rays. The shadows cast by the barium show the lining of the colon. This procedure takes 30 to 60 minutes.

2. Common Reasons for a Barium Enema

   Some of the more common reasons why your doctor would order a barium enema include:

   • A change in bowel habit including constipation or diarrhea
   • Abdominal pain
   • A change in color of stools including black stools or red blood in the stool
   • A change in the shape of your stool, especially thin stools (pencil stools)
   • A test indicates the presence of blood in the stool
   • Anemia (low blood)
   • A history of previous bowel cancer or polyps
   • A strong family history of bowel cancer or polyps
   • Unexplained weight loss

3. Who should not have a Barium Enema?

   The barium enema, and indeed all x-ray examinations, should not be performed in pregnant women except when the information provided by the test is vital to treatment of the patient and there are no suitable alternatives. Barium enema should not be done if there has been surgery on the colon or rectum (including removal of polyps) within the last two weeks. The barium enema is usually not indicated for a sudden attack of bleeding or abdominal pain.

4. How do I prepare for the test?

   The presence of stool within the colon may mask or be confused with abnormalities on the barium enema. Preparation for barium enema is aimed at clearing the colon of stool. If, by the time of your examination, your bowel movements are not clear, you should notify the receptionist or technologist. You may take your medications with sips of water on the morning of the examination. If you are being treated for diabetes, ask your doctor if you need to modify the timing or dose of your diabetes medications.

   You will need to purchase at the Pharmacy:

   • 1 Box Pico-Salax containing two packets - You will need to use both packets at times listed below.
   • Bisacodyl Laxative (such as Dulcolax) - 4 tablets (5mg each)

   Day before your examination:
   1. No solid food, only clear liquids the day prior to procedure (Clear Liquids: apple juice, jello, chicken broth, Gatorade, popsicles, pop, water, ice, white grape juice or white cranberry juice, black tea and coffee no milk and no cream)
   2. At 8:00 a.m., 4 Bisacodyl (Dulcolax) tablets (5mg each) by mouth with 1-2 glasses of water.
   3. a) Take 1st packet of Pico-Salax at about 11:00 am - mix it in a 5-ounce (150ml) mug of cold water. The mixture becomes warm, let it cool before drinking. You must continue to stir while drinking to ensure all the laxative has dissolved. Drink one glass of room temperature water each hour over the next three hours. Most people will have 3-6 watery bowel movements. You will be making several trips to the bathroom throughout the afternoon. This could impact your work and ability to perform work duties.
      b)Take 2nd packet of Pico-Salax at about 3:00 p.m. - mixing it the same as the first packet.
      Additional clear liquids can be drunk up to midnight.

   Day of Examination:

   Continue with no solid food. You may drink 1-2 cups of clear liquids the day of the examination. You may take your required medication as usual, except if it must be taken with solid food.

5. Who performs the examination?

   The examination is performed by an x-ray technologist and a radiologist (a doctor who specializes in performing x-ray procedures and reading x-rays and other imaging studies).

6. What happens during the examination?

   After registering with the receptionist, you will be asked to change into a gown. You will have to remove all of your clothing including bra and underpants. You will be taken to the examination room which contains a large (very hard) x-ray table with an x-ray machine overtop. A lubricated, smooth plastic tube, about as big around as your index finger, will be inserted into your rectum. The tube has a cuff which is inflated like a balloon to help prevent the tube from coming out of your rectum. When the cuff is inflated, you will probably have the desire to have a bowel movement. Barium is then allowed to flow into the rectum by gravity (this may increase the desire to have a bowel movement). In most cases, air is also puffed into the rectum. You may have to "clamp down" on the tube with your bottom in order to prevent the escape of barium and air. The barium, and especially the air, may cause abdominal cramps. These cramps vary in severity from patient to patient but most have mild cramps. Rarely, these cramps may continue for up to a day after the test.

   You will be required to roll like a log on the table to coat the walls of your bowel. A series of pictures will be taken in various positions, usually including standing up. Additional pictures taken with a larger camera will follow these "snap shots". During most of the pictures you will have to hold your breath.

   The tube in your rectum will then be removed and at least one further x-ray will be taken with the tube out. You will then be allowed to use the washroom adjoining the examination room.

7. What can I expect after the examination?

   Bowel movements may contain white components (barium) for a variable period of time following the examination. While you may have a small amount of blood in your stool following the examination, a large amount of blood or persistent bleeding should prompt a call to your doctor. You may have mild abdominal cramps for up to a day following the procedure. There is a small chance that the residual barium may harden in the colon producing constipation. This can be avoided by drinking plenty of fluids after the test, eating normally and taking a mild laxative if you have tendency to be constipated.

8. What are the risks of the procedure?

   All x-rays involve receiving a controlled amount of radiation. The risk associated with the radiation received during a single x-ray examination is very small. While the exact likelihood is controversial, there is a very small chance of the radiation contributing to the development of a malignancy many years in the future. The risks involved in everyday activities such as driving a car are far higher. Generally, the risk of not doing the x-ray far outweighs the risk of the small amount of radiation involved.

   There is a very small risk of perforating the rectum with the rectal tube. Very rarely, barium may leak out of the colon through a previous unknown perforation and cause inflammation in the surrounding tissues. As mentioned above, occasionally residual barium may harden in the colon after the procedure. In a small number of cases, this may lead to obstruction (blockage) of the colon. Allergy to barium or the rectal tube is extremely rare.

9. Who interprets the results and how do I get them?

   The results are interpreted by one of our radiologists and the results are sent to the doctor who ordered the barium enema by courier or fax.

   Arrangements to discuss the results of the barium enema can be made with the doctor who ordered it.