A barium enema, also called a Lower Gastro-Intestinal Series, is a medical test that involves filling the colon with barium sulfate and sometimes air and taking x-rays. Barium sulfate is opaque to x-rays, so this allows the radiologist to get a detailed look at the colon to search for abnormalities such as ulcers, hemorrhoids, polyps, and blockages.

Before the procedure, a limited diet of clear liquids must be followed for 1-3 days, and a series of laxatives must be taken to clear out the colon. The milder the laxatives, the longer the diet must be followed. On the day of the exam, the patient must fast. At the exam, the patient will be asked to undress and wear a robe, and to lie down on a movable table. A lubricated enema tube is inserted and a small balloon at the end is inflated to help hold in the barium. Barium sulfate is allowed to slowly flow in to the colon. The patient may be tilted up and down to allow the barium to flow in to as much of the colon as possible to get the most accurate pictures. Some x-rays are taken. Now, if this is to be a single-column barium enema, more pictures will be taken in various positions and then the procedure will end. However, most radiologists believe that a double-contrast barium enema gives a much more accurate view of the colon, so if the patient is cooperative, not elderly, and not in pain, a double-contrast test will generally be performed. This involves inserting air in to the colon. This can cause cramps. (The whole procedure may cause cramps, but this is the most likely spot.) Then more x-rays are taken. The patient will be asked to move in to different positions so that pictures can be taken from all sides. The radiologist will review the x-rays to make sure that there is an adequate view of everything. If no more pictures are needed, the barium sulfate and air are allowed to flow out of the tube, the tube is removed, and the patient is helped to the bathroom so they can expell any remaining air and barium. If everything goes smoothly, whole procedure takes only about 15 minutes.

A barium enema is performed when some problem in the colon is suspected. The most common reason is unexplained cramps, rectal bleeding, or bloody stool. A barium enema may also be performed as a screening test where there are no symptoms but the patient is at risk of colon cancer - generally people over 50 or with a family history of colon cancer or familial polypitis. Because it involves a lot of radiation in the abdomen, a barium enema should not be performed is there if any chance that the patient may be pregnant. Tests similar in function to a barium enema include colonoscopy and sigmoidoscopy.

A note to patients facing a barium enema:
(I'm writing this because I was scared to death of the procedure, and the only information I could find on the web was either really vague or pornographic.)

First off, it's not that bad. It's not fun, but don't freak out. Call it a lower G-I series in your head - that's not as scary sounding as barium enema. Probably the worst part isn't the enema, but the preparation. You feel hungry and grumpy for a few days and laxatives just aren't a barrel of laughs. (If you can, though, go for the milder laxatives and the longer liquid diet. You'll be very hungry, but the other option is generally taking Colyte or Go-lyte-ly or something, which are harsh as hell and involve drinking 4 liters of vile gak. Go for the milder stuff.) The actual procedure is only about 15 minutes, and doesn't really hurt. It's uncomfortable, but breathe deeply and think of how you'll be able to eat solid food again as soon as it's over, and it'll fly by. The only really unpleasant part is when they insert air. This feels really weird, and it can give you cramps. If it does, or if anything does, tell them immediately and they'll stop for a minute. If they stop or slow down, the feeling goes away, so don't keep quiet. Bring a snack with you to munch on when the test is over, and then go have a nice lunch. Try to schedule the procedure for the morning; then you don't have to fast as long. While you're preparing, sleep as much as you can. You don't feel grumpy and hungry when you're asleep. Once you start on the laxatives, you might want to stay home, because you will spend a lot of time getting to know your bathroom better. Bring your teddybear along if you want. The radiologist won't mind.

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