Norm of Barium Enema (BE)
Requires interpretation. Characteristics examined include filling, passage pattern of barium, and the contour, patency, position, and mucosal pattern of the colon.
Usage of Barium Enema (BE)
Part of the diagnostic workup for bowel obstruction, celiac sprue, colorectal cancer, diverticulitis, diverticulosis, gastroenteritis, Hirschsprung's disease, intestinal cancer, intestinal polyps, intussusception, irritable bowel syndrome, rectal stenosis, stercoral appendicular fistula and ulcerative colitis.
Description of Barium Enema (BE)
A fluoroscopic and radiographic examination of the large intestine after rectal instillation of barium sulfate with or without air for the purpose of identifying structural abnormalities or slowing of normal intestinal activity. The American Cancer Society recommends a screening double-contrast barium enema every 5 years beginning at age 50. Positive results should be followed with a colonoscopy.
Professional Considerations of Barium Enema (BE)
Consent form NOT required.
Constipation, dizziness, infection, intestinal impaction, rectal or bowel perforation, rectovaginal perforation, and vasovagal reaction.
Severe active ulcerative colitis accompanied by toxicity and megacolon, perforated intestine, toxic megacolon, tachycardia.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk-benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/fetus from occupational exposure not exceed 0.5 rem (5 mSv). Risk of exposure to the uterus from a barium enema is 2–4 rad. Radiation dose to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses.
- Laxatives or cathartic suppositories, or both, are usually indicated the day before and on the morning of the test to facilitate complete emptying of the intestines. However, they may be contraindicated for certain clients with conditions such as ulcerative colitis or intestinal obstruction. There is no difference between using Picolax or Fleet Phospho-Soda as laxatives except taste and Picolax provokes less nausea.
- If the client is pregnant, notify the physician before examination preparation.
- See Client and Family Teaching.
- After baseline abdominal radiographs are taken, the client lies in a Sims' position on a tilt table and receives a slow administration of barium sulfate or barium sulfate with air insufflation through a rectal tube.
- As the client assumes different positions, the filling is monitored by fluoroscopy.
- Spot films are taken during and after the filling.
- The rectal tube is withdrawn, and the barium expelled, after which another film is taken to examine the pattern of the intestinal mucosa and to determine how well emptying has occurred.
- Where not contraindicated, the client should increase fluid intake for 24–48 hours.
- Where not contraindicated, a mild cathartic may be prescribed to facilitate emptying of the barium from the intestine.
- Stools should be inspected by the client or the health care professional for passage of barium for 48 hours. Barium stools will look chalky white in color.
- Failure to have a bowel movement within 2 days after the test should be reported to the physician.
Client and Family Teaching
- It is important to have the bowel emptied of stool before the procedure. A low-residue diet may be prescribed for 1–3 days before the test, although it does not offer any advantage over a normal diet in preparation for the test if purgatives are used.
- A clear liquid diet is usually prescribed for 1 day before and on the morning of the test. A normal diet may be resumed after the procedure.
- A laxative may be prescribed before and after the procedure.
- The procedure takes about 60 minutes. It is important to hold your breath when you are asked to do so during the procedure.
- Make sure all the barium empties from the intestinal tract after the procedure. Drinking fluids and taking laxatives or enemas after the procedure may be prescribed for this purpose.
- See Postprocedure Care.
- Call the physician if stomach or lower abdominal pain is experienced or if stools are much smaller than the normal diameter.
Factors That Affect Results
- Failure to achieve complete emptying of the intestinal tract before the test may necessitate a repeated barium enema.
- The barium enema should be performed before a barium swallow.
- There is evidence that occult stool testing reduces mortality from colon cancer. There is no similar current evidence regarding BE for screening of colon cancer.
- Absorbed dose is 20–80 mGy to the embryo and 10–20 mGy to the fetus.