Prior to a barium enema, a technologist will ask you about your medical history, reason for having the test, any allergies you may have, whether you took the preparation, and if you had any reaction from preparation.
The technologist will then position you on an x-ray table and take an x-ray picture of your abdomen. Then, you may have to wait while your technologist consults with the radiologist who is doing the test. The main issue is whether you are "cleaned out" enough. If you have had a recent upper GI series or CT with oral contrast, that material may still be in your body, which will postpone the BE.
If, on the other hand, the test is a go, the technologist will get you back up on the table, insert an enema tip into the rectum, and inflate a balloon at the tip of the enema tube. Cooperative patients may be able to hold in enemas without balloons. Most radiologists, however, use balloons because they seem to help patients hold enemas. From your perspective, the inflation of the balloon causes the rectum to distend which causes you to have the feeling of imminent defecation. Patients need to understand that that feeling is a false one and they should try to ignore it.
In some radiology departments, it's the technologist who inserts and inflates the tube. In other places, the radiologist does it.
So now you are ready, and the radiologist should come in the room very shortly. As a patient lying on a cold x-ray table, you have a right to expect prompt service. If you don't get it, you have the right to question the technologist. You also have the right to as much privacy as possible. Generally you should be covered, and the door to your exam room should be closed. Being a patient is not a reason to be stripped of all dignity. If you feel your privacy is inadequate, you should speak up.
When the radiologist arrives, you will have one of two different procedures, a single column or air contrast study. Generally speaking, you will have an air contrast study if you are not elderly, seem cooperative, and are able to move around reasonably well on the x-ray table. Of the two tests, the air contrast study, in which the walls of the large bowel are coated with barium, is the more sensitive. Although there are some radiologists (in the minority) who feel that a "good" single column study is as good.
The specifics, of course, will vary from one institution to another. Generally, you will be asked to lie facing down on the table while the radiologist opens the valve on the tube coming from the barium bag. With the introduction of the barium into the rectum, you will have a definite cramping feeling, and you may feel like you have to defecate.
The radiologist can see, using fluoroscopy, the irritability and spasm of the end of your large bowel that is causing the cramping. It should ease in less than a minute. If it doesn't, barium may have to be expelled from the colon and the colon refilled. Or, it may be helpful to inject glucagon, a medication that relaxes the large bowel, through a skinny (25 gauge) needle into a vein in your arm. Most of the time, a little pleasant chatter can affect relaxation.
Now and then, the radiologist will hit a switch that makes a fair amount of noise and vibration. That signals that the radiologist is taking a "spot film" of the fluoroscopy that becomes a permanent record of the area being examined.
Barium Enema Air Contrast Technique
The air contrast technique is somewhat more involved than the single column study. The goal is to coat the walls of the entire large bowel with contrast and leave as much air in the lumen (hole of the tube) as possible. That particular combination gives the radiologist the best picture of the large bowel. To do that, your body will be rolled around so that gravity can get the heavy barium completely around from the rectum to where the large bowel begins and the small bowel ends. If you are having an air contrast study, the radiologist may even ask you to stand to mix up the barium and air. You can move as slowly as you'd like, and you should ask for help if you have difficulties.
To help you stand, most fluoroscopic x-ray tables rise from 180 degrees (flat) to 90 degrees (upright). If you plant your feet on the platform at the bottom of the table, you will be standing on the platform when the table reaches its upright position. It can be a strange feeling, especially with everything else that is happening to you. If you feel unsteady, you can ask for a handgrip or ask not to be moved up any further. Most patients are able to tolerate the upright position.
The upright position allows the heavy barium to coat the more dependent portions of the cecum, which is at the beginning of the large bowel, and allows for the best air-filled pictures of the uppermost parts of the colon, the splenic and hepatic flexures.
In the upright position, it is not unusual to experience a little leaking around the rectal balloon. For this reason, it is wise for air contrast patients to remove their shoes. If you find yourself standing with an enema tip in your rectum and shoes on your feet, ask the radiologist or technologist for a towel to cover your shoes. Often the radiologist will want to have you expel the excess barium back into the tube while you are upright. As soon as the valve is opened, you should feel much better.
After that, you will be lowered, and the end is in sight. The radiologist will often want to inject more air to distend the large bowel fully. This is a negotiation, keeping the patient's rights in mind at all times. You may also get spun around another time or two, before the radiologist is done. The radiologist will then leave and the technologist will stay with you and take many x-rays of your abdomen in all different positions. The valve on the tube will be opened, and the barium and excess air will be allowed to drain. Then the balloon will be deflated and the tube will be removed. You will have to wait for the technician to take a picture of your abdomen after all the excess barium has been allowed to drain. Then you'll wait some more until the film is looked at by the radiologist. Finally, you'll be able to clean yourself off as best as you can and get dressed.
What Happens After Barium Enema?
The good news is you'll be able to go back home or back to work after the procedure. You may pass some of the white barium for a few days. Drinking lots of water helps. Rarely, a patient may see some blood in the toilet, which is caused by the inflated balloon. A little probably means little; a lot could be serious and you should call your personal physician.