Barium enema is a fluoroscopic technique performed to diagnose, structural or functional abnormalities of the large intestine by using barium sulphate contrast media.


Indication for the examination are suspected mass , polyps,abdominal pain, chronic diarrhea, loss of weight, diverticulosis, melena,partial obstruction,large intestine volvulus.


Contraindications for the procedure are bleeding piles, recent biopsy, incomplete bowel preparation, suspected fistula, suspected perforation,  suspected pregnancy, Complete bowel obstruction.

Contrast medium

Contrast medium used for the procedure is barium sulphate powder. 

Patient preparation

The procedure is done by taking accurate and clear history, a low residue diet for 2 days prior to the examination, a laxative should be given  on the evening and NPO for 6 hours prior to the examination, plain water enema must apply to clear fecal matter and ask patient to remove clothing and wear hospital gown.

Plain radiograph

Plain radiograph of the abdomen is taken to see the bowel preparation. If the  residual fecal matter is present in the bowel, the examination should be postponed for the next day.


Technique for procedure is done by patient lie on their side on x ray table and an injection of a medication called buscopan is given into arm to prevent involuntary bowel movement.

Single contrast study

Single contrast study is done by inserting small soft  tube into rectum during expiration phase  and barium is passed through the tube and  patient are allowed to move around bit to help the barium spread along the bowel then several  x ray films are taken.

Double contrast study

Double contrast study  is done by pushing air after the barium in the rectum  for more detailed image  and this is called an air contrast barium enema.


Films taken after the procedure are PA for entire colon, true lateral for rectosigmoid and evaluation of pre sacral space, pelvis AP for rectum and sigmoid, RPO and LPO for splenic or heptic flexure and colon.After the evacuation, full length abdomen x ray is done to see the residual contrast.

After the procedure patient is allowed to leave the exam and should be warned that his bowel will be white for a few days .The patient should advised to drink adequate volumes of water to avoid constipation.


Complications can be inflammation in tissues surrounding the colon, obstruction in the exam gastrointestinal tract, tear in the colon wall. 

Submitted by 

Ms Divya Jha Faculty of Radiology