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Baruim enema (BE) is a test that strikes terror in the hearts of those who need to have it. Most of us would rather pass through our lives without ever thinking about enemas of any sort. The truth is, if done properly, a barium enema need not be an awful ordeal. Basically the barium enema is a fluoroscopic test used to study the large bowel, or colon.

There are two basic types of barium enemas: The regular, or single contrast, barium enema and the air contrast barium enema. The regular, or single contrast, barium enema is performed using only barium; the air contrast barium enema uses barium and together.

The good news is that there are few complications to barium enemas. Most complications arise from the insertion of the enema tube and the inflation of the little balloon at the enema tip. Very rarely, patients may be allergic to the latex in the balloon. Overinflation of the balloon can result in tearing of the rectal wall, which can be a very serious complication. This complication is most apt to occur when the lining of the rectum is inflamed, such as in ulcerative colitis. It would be very unusual to overinflate a normal rectum.

When your time comes, a technologist will call for you. You will be interviewed about your medical history, reason for having the test, any allergies you may have, whether you took the preparation, and if you had a result from the 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.

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.