Barium enema investigation, barium xray investigation of colon polyps & cancer

Barium enema is often used to investigate colon cancer warning signs such as blood in the toilet of blood on the toilet paper, a sign or rectal bleeding (passing blood from the back passage). It can be due to other causes such as colon polyps, diverticular disease, a feature of hemorrhoid symptoms and angiodysplasia (blood vessel bleeding in the colon. ibs patients can sometimes bleed, particularly in constipated sufferers from hemorrhoids, but it is not part of the syndrome itself. Barium xray is sometimes used as an alternative to colonoscopy, a flexible camera test of the bowel. While there is no such thing as an 'ibs investigation', as it is diagnosed on history, the test is used to exclude other causes of bowel symptoms. It is an X-ray test where a milky dye or barium is passed, via an enema, through the anus or 'back passage' into the large bowel. This shows up the inner lining of the bowel and can highlight colon polyps, bowel cancers and narrowing’s or ‘strictures’ such as diverticular disease by coating over these areas as it passes to the Cecum (Caecum), or end part of the start of the large bowel.



These tests are normally requested in patients that don't wish to undergo Colonoscopy, in those with potentially difficult colons to examine and people that have perhaps had symptoms not directly attributable to the Irritable Bowel Syndrome or IBS such as rectal bleeding (bleeding from the back passage). To perform the barium enema test, your bowel will need to be emptied with laxatives plus sometimes an enema or suppository. This is called 'bowel prep' and the type of medication will be determined by your local hospitals policy.

On the day of the barium enema test, you will be asked to go to the radiology or X-ray department. A needle will be inserted in your hand or arm through which medication can be given (normally Buscopan or Hyoscine Butylbromide) back passage through which ‘dye’ is passed. Sometimes air is also passed into the bowel to inflate it. This is called a double contrast barium enema. You will then be placed in different positions and angles for the ‘dye’ to pass through the Colon to the cecum (Caecum) and pictures taken to be assessed by a qualified X-ray doctor or Radiologist.

Are there any problems with the test?

Yes, occasionally problems can arise, but thankfully they are rare. The test can be uncomfortable (of particular note, ibs patients often get more pain when air is passed into the bowel) and you should be prepared for this. The dye usually contains Iodine and some people are allergic to this. It is important to let the X-ray department know this beforehand if you are aware of this already. Very rarely, perforation of the bowel can occur. If this happens then you are likely to require an operation, but as stated this is very rare (I haven't seen this happen in the 16 years I have been practicing medicine.

Can anyone have a Barium xray?

The answer to this is definitely NO. It should only be done when there is a good clinical need for the investigation. If you are pregnant or have a latex allergy then this test should be avoided (the enema tube usually has a latex balloon on the end! Also, if you have had a recent biopsy from the rectum or anus then the test should be delayed as there is an increased risk of perforation (putting a hole in the bowel).

Are there any problems with the test?

Yes, occasionally problems can arise, but thankfully they are rare. The test can be uncomfortable and you should be prepared for this. The dye usually contains Iodine and some people are allergic to this. It is important to let the X-ray department know this beforehand if you are aware of this already. Very rarely, perforation of the bowel can occur. If this happens then you are likely to require an operation, but as stated this is very rare (I haven't seen this happen in the 16 years I have been practicing medicine).

In conclusion, barium Enema is a good bowel investigation for patients with colon cancer warning signs, in highlighting colon polyps and strictures such as those seen in diverticular disease. It won't diagnose ibs, but will help to exclude other causes of bowel symptoms.


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