Double-contrast barium enema

A double-contrast barium enema – also called a barium enema – is a type of colon screening. The X-ray test uses contrasting agents to provide a detailed view of your large intestine (colon) to find possible abnormalities. This helps diagnose gastrointestinal disorders and colorectal cancer. It’s an alternative to a colonoscopy and other gastrointestinal imaging tests (GI imaging).

What is the double-contrast barium enema technique?

The name of this test comes from the two contrasting agents – barium liquid and air – and the method in which the agents are injected into your colon and rectum, also known as an enema.

Barium liquid – a metallic substance – is used to coat the lining of your colon. This liquid is injected into your rectum with a small tube. Your colon is filled with air after the barium liquid is added. Air appears black on X-ray film, contrasting with the barium liquid that appears white. This barium coating, along with the air, gives a clearer visualization of your entire colon than a standard X-ray provides.

Reasons you may need a double-contrast barium enema

If you are at high risk of colorectal cancer, screenings are recommended to help you catch any abnormalities such as lesions, polyps or other signs of cancer when it's in its earliest and most treatable stages.

If you can’t undergo a colonoscopy due to other medical conditions, a barium enema is an alternative screening test. It’s also a common GI imaging test for other conditions, such as:

• Ulcerative colitis
• Irritable bowel syndrome
• Crohn’s disease
• Unusual bloating or lower abdominal pain
• Chronic diarrhea or constipation
• Unexplained weight loss
• Rectal bleeding

Double-contrast barium enema benefits and risks

Benefits of the barium enema test include:

• Identifies lesions in the entire colon
• Lower risk than other GI imaging tests
• Done without sedation
• The test is usually done within 45 minutes

As with any medical procedure, it’s important to discuss potential risks with your provider. Although complications with a barium enema test are rare, there are some risks. These include:

• Allergic reaction to barium
• Possible tear in the colon wall
• Inflammation in surrounding colon tissues
• Constipation

Colonoscopy vs barium enema

You may choose a barium enema since it’s less invasive than a colonoscopy. However, there is one possible disadvantage to consider with a barium enema. If polyps or other signs of cancer are found, they cannot be removed or biopsied, as they can be during a colonoscopy. A diagnostic colonoscopy would be recommended as the next step.

Unlike a colonoscopy, a barium enema test is done without sedation and can be uncomfortable. It does have a faster recovery time since there is no sedation.

Preparing for a double-contrast barium enema

Preparing for GI imaging tests like a barium enema requires careful planning. Your colon will need to be empty for the test, so you’ll need to follow your provider’s instructions for the days leading to your test. This commonly includes a liquid diet for 24 hours beforehand and a restricted intake of dairy products. It may also include some laxative medications.

Double-contrast barium enema recovery

The recovery time after a barium enema is relatively short. It’s important to drink plenty of fluids and you may resume your normal activities as soon as you feel up to it. If you experience any complications after the exam – like constipation – contact your provider.