Barium enema

Lower gastrointestinal series; Lower GI series; Colorectal cancer – lower GI series; Colorectal cancer – barium enema; Crohn disease – lower GI series; Crohn disease – barium enema; Intestinal blockage – lower GI series; Intestinal blockage – barium enema

A barium enema is a special x-ray of the large intestine, which includes the colon and rectum.

How the Test is Performed

This test may be done in a doctor’s office or hospital radiology department. It is done after your colon is completely empty and clean. Your doctor will give you instructions for cleansing your colon.

During the test:

• You lie flat on your back on the x-ray table. An x-ray is taken.
• You then lie on your side. The health care provider gently inserts a well-lubricated tube (enema tube) into your rectum. The tube is connected to a bag that holds a liquid containing barium sulfate. This is a contrast material that highlights specific areas in the colon, creating a clear image.
• The barium flows into your colon. X-rays are taken. A small balloon at the tip of the enema tube may be inflated to help keep the barium inside your colon. The provider monitors the flow of the barium on an x-ray screen.
• Sometimes a small amount of air is delivered into the colon to expand it. This allows for even clearer images. This test is called a double contrast barium enema.
• You are asked to move into different positions. The table is slightly tipped to get different views. At certain times when the x-ray pictures are taken, you are told to hold your breath and be still for a few seconds so the images will not be blurry.
• The enema tube is removed after the x-rays are taken.
• You are then given a bedpan or helped to the toilet, so you can empty your bowels and remove as much of the barium as possible. Afterward, 1 or 2 more x-rays may be taken.

How to Prepare for the Test

Your bowels need to be completely empty for the exam. If they are not empty, the test may miss a problem in your large intestine.

You will be given instructions for cleansing your bowel using an enema or laxatives. This is also called bowel preparation. Follow the instructions exactly.

For 1 to 3 days before the test, you need to be on a clear liquid diet. Examples of clear liquids are:

• Clear coffee or tea
• Fat-free bouillon or broth
• Gelatin
• Sports drinks without added color
• Strained fruit juices
• Water

How the Test will Feel

When barium enters your colon, you may feel like you need to have a bowel movement. You may also have:

• A feeling of fullness
• Moderate to severe cramping
• General discomfort

Taking long, deep breaths may help you relax during the procedure.

It is normal for the stools to be white for a few days after this test. Drink extra fluids for 2 to 4 days. Ask your doctor about a laxative if you develop hard stools.

Why the Test is Performed

Barium enema is used to:

• Detect or screen for colon cancer
• Diagnose or monitor ulcerative colitis or Crohn disease
• Diagnose the cause of blood in stools, diarrhea, or very hard stools (constipation)

The barium enema test is used much less often than in the past. Colonoscopy is done more often now.

Normal Results

Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.

What Abnormal Results Mean

Abnormal test results may be a sign of:

• Blockage of the large intestine ( Hirschsprung disease )
• Crohn disease or ulcerative colitis
• Cancer in the colon or rectum
• Sliding of 1 part of the intestine into another ( intussusception )
• Small growths that stick out of the lining of the colon, called polyps
• Small, bulging sacs or pouches of the inner lining of the intestine, called diverticulosis
• Twisted loop of the bowel ( volvulus )

Risks

There is low radiation exposure. X-rays are monitored so that the smallest amount of radiation is used. Pregnant women and children are more sensitive to x-ray risks.

A rare, but serious, risk is a hole made in the colon (perforated colon) when the enema tube is inserted.

Colonoscopy

Colon cancer – colonoscopy; Colorectal cancer – colonoscopy; Colonoscopy – screening; Colon polyps – colonoscopy; Ulcerative colitis – colonoscopy; Crohn disease – colonoscopy; Diverticulitis – colonoscopy; Diarrhea – colonoscopy; Anemia – colonoscopy; Blood in stool – colonoscopy

A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope.

The colonoscope has a small camera attached to a flexible tube that can reach the length of the colon.

How the Test is Performed

Colonoscopy is done most often in a procedure room at your doctor’s office. It can also be done in the outpatient department of a hospital or medical center.

• You will be asked to change out of your street clothes and wear a hospital gown for the procedure.
• You are likely given medicine into a vein (IV) to help you relax . You should not feel any pain. You may be awake during the test and may even be able to speak. You will probably not remember anything.
• You lie on your left side with your knees drawn up toward your chest.
• The colonoscope is gently inserted through the anus. It is carefully moved into the beginning of the large intestine. The scope is slowly advanced as far as the lowest part of the small intestine.
• Air is inserted through the scope to provide a better view. Suction may be used to remove a fluid or stool.
• The doctor gets a better view as the scope is moved back out. So, a more careful exam is done while the scope is being pulled back.
• Tissue samples ( biopsy ) or polyps may be removed using tiny tools inserted through the scope. Photos may be taken using the camera at the end of the scope. If needed, procedures, such as laser therapy , are also done.

How to Prepare for the Test

Your bowel needs to be completely empty and clean for the exam. A problem in your large intestine that needs to be treated may be missed if your intestines are not cleaned out.

Your health care provider will give you the steps for cleansing your bowel. This is called bowel preparation. Steps may include:

• Using enemas
• Not eating solid foods for 1 to 3 days before the test
• Taking laxatives

You need to drink plenty of clear liquids for 1 to 3 days before the test. Examples of clear liquids are:

• Clear coffee or tea
• Fat-free bouillon or broth
• Gelatin
• Sports drinks without added color
• Strained fruit juices
• Water

You will likely be told to stop taking aspirin, ibuprofen, naproxen, or other blood-thinning medicines for several days before the test. Keep taking your other medicines unless your doctor tells you otherwise.

You will need to stop taking iron pills or liquids a few days before the test, unless your provider tells you it is OK to continue. Iron can make your stool dark black. This makes it harder for the doctor to view inside your bowel.

How the Test will Feel

The medicines will make you sleepy so that you may not feel any discomfort or have any memory of the test.

You may feel pressure as the scope moves inside. You may feel brief cramping and gas pains as air is inserted or the scope advances. Passing gas is necessary and should be expected.

After the exam, you may have mild abdominal cramping and pass a lot of gas. You may also feel bloated and sick to your stomach. These soon go away.

You should be able to go home 1 hour after the test. You must plan to have someone take you home after the test, because you will be woozy and unable to drive. The providers will not let you leave until someone arrives to help you.

When you are home, follow instructions on recovering from the procedure. These may include:

• Drink plenty of liquids. Eat a healthy meal to restore your energy.
• You should be able to return to your regular activities the next day.
• Avoid driving, operating machinery, drinking alcohol, and making important decisions for at least 24 hours after the test.

Why the Test is Performed

Colonoscopy may be done for the following reasons:

• Abdominal pain, changes in bowel movements, or weight loss
• Abnormal changes (polyps) found on sigmoidoscopy or x-ray tests ( CT scan or barium enema )
• Anemia due to low iron (usually when no other cause has been found)
• Blood in the stool , or black, tarry stools
• Follow-up of a past finding, such as polyps or colon cancer
• Inflammatory bowel disease ( ulcerative colitis and Crohn disease )
• Screening for colorectal cancer

Normal Results

Normal findings are healthy intestinal tissues.

What Abnormal Results Mean

Abnormal test results may mean any of the following:

• Abnormal pouches on the lining of the intestines, called diverticulosis
• Areas of bleeding
• Cancer in the colon or rectum
• Colitis (a swollen and inflamed intestine) due to Crohn disease, ulcerative colitis, infection, or lack of blood flow
• Small growths called polyps on the lining of your colon (which can be removed through the colonoscope during the exam)

Risks

Risks of colonoscopy may include any of the following:

• Heavy or ongoing bleeding from biopsy or removal of polyps
• Hole or tear in the wall of the colon that requires surgery to repair
• Infection needing antibiotic therapy (very rare)
• Reaction to the medicine you are given to relax, causing breathing problems or low blood pressure

Rectal biopsy

Biopsy – rectum; Rectal bleeding – biopsy; Rectal polyps – biopsy; Amyloidosis – rectal biopsy; Crohn disease – rectal biopsy; Colorectal cancer – biopsy; Hirschsprung disease – rectal biopsy

A rectal biopsy is a procedure to remove a small piece of tissue from the rectum for examination.

How the Test is Performed

A rectal biopsy is usually part of anoscopy or sigmoidoscopy . These are procedures to view inside the rectum.

A digital rectal exam is done first. Then, a lubricated instrument (anoscope or proctoscope) is placed into the rectum. You will feel some discomfort when this is done.

A biopsy can be taken through any of these instruments.

How to Prepare for the Test

You may get a laxative, enema, or other preparation before the biopsy so that you can completely empty your bowel. This will allow the doctor a clear view of the rectum.

How the Test will Feel

There will be some discomfort during the procedure. You may feel like you need to have a bowel movement. You may feel cramping or mild discomfort as the instrument is placed into the rectal area. You may feel a pinch when a biopsy is taken.

Why the Test is Performed

A rectal biopsy is used to determine the cause of abnormal growths found during anoscopy, sigmoidoscopy, or other tests. It can also be used to confirm the diagnosis of amyloidosis .

Normal Results

The anus and rectum appear normal in size, color, and shape. There should be no evidence of:

• Bleeding
• Polyps
• Hemorrhoids
• Other abnormalities

No problems are seen when the biopsy tissue is examined under a microscope.

What Abnormal Results Mean

This test is a common way to determine the specific causes of abnormal conditions of the rectum, such as:

• Abscesses
• Colorectal polyps
• Infection
• Inflammation
• Tumors
• Amyloidosis
• Crohn disease
• Hirschsprung disease in infants
• Ulcerative colitis

Risks

Risks of a rectal biopsy include bleeding and tearing.