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Barium Enema

What is a barium enema test?

A contrast barium enema produces images of the large intestine. It includes the colon and anus.

This test is sometimes called a lower GI series. Its full name is lower gastrointestinal tract radiography.

A doctor may want your child to have this test if they have:

  • Problems with bowel movements
  • Changes in bowel habits
  • Unexplained weight loss
  • Stomach pain
The lower gastrointestinal tract includes the large intestine, the appendix, and the rectum.

The lower gastrointestinal tract includes the large intestine, the appendix, and the rectum.

A radiologist and radiological technologist perform the test.

This test uses a form of x-ray called fluoroscopy. That means it uses a small amount of ionizing radiation to produce images. The amount of radiation is very small.

The medical benefits outweigh the small amount of radiation exposure. You should discuss any concerns with your child’s care team.

The test also uses a contrast liquid. The liquid is either a milky white substance called barium or a clear liquid containing iodine. The contrast liquid helps the bowel to appear more clearly on the viewing screen.

Fluoroscopy makes it possible to see internal organs in motion. It’s like a “live” X-ray. It allows doctors to see the colon and rectum and how they function.

Fluoroscopic side view of a lower GI series test in a pediatric cancer patient.

Fluoroscopic side view of a lower GI series test in a pediatric cancer patient.

The small green arrow points to a problem area in the large intestine on an image from a lower GI series test.

The small green arrow points to a problem area in the large intestine on an image from a lower GI series test.

How to prepare for a barium enema test

To get the best image possible, the colon must be empty. Your child must prepare for a barium enema exam. Follow the instructions based on your child’s age.

  1. Newborn to 18 months old

    After 8 p.m. the night before the barium enema

    • Do not give your child any solid food or formula.
    • Give your child clear liquids only. This can include Pedialyte®, broth, gelatin, popsicles, and water.

  2. 18 months to 4 years old

    Day before the barium enema

    • After noon, give your child only clear liquids. This can include Pedialyte®, broth, gelatin, popsicles, and water.
    • At 2 p.m., give your child ¼ bottle or 2.5 oz (75 mL) of chilled magnesium citrate by mouth. Your pharmacy may have cherry syrup for you to add to this lemon-lime liquid. Make sure your child drinks this dose within 20 minutes. Have your child drink an 8-ounce glass of water or other clear liquid after taking this dose.
    • At 7 p.m., give your child another ¼ bottle or 2.5 oz (75 mL) of the magnesium citrate by mouth. Make sure your child drinks this dose within 20 minutes. Have your child drink an 8-ounce glass of water or other clear liquid after taking this dose.

    Your child’s stools should be watery and clear by 10 p.m. the night before the procedure.

  3. 4 years to 8 years old

    Two days before the barium enema

    • Give your child one 5 mg bisacodyl tablet by mouth. This pill must be swallowed. Do not let your child chew this pill.

    The day before the procedure

    • After noon, give your child only clear liquids. This can include Pedialyte®, broth, gelatin, popsicles, and water.
    • At 2 p.m., give your child ½ bottle or 5 ounces (150 mL) of chilled magnesium citrate to drink. Your pharmacy may have cherry syrup for you to add to this lemon-lime liquid if your child prefers that flavor. Make sure your child drinks this dose within 20 minutes. Have your child drink an 8-ounce glass of water or other clear liquid after taking this dose.
    • At 7 p.m., give your child another ½ bottle or 5 ounces (150 mL) of the magnesium citrate to drink. Make sure your child drinks this dose within 20 minutes. Have your child drink an 8-ounce glass of water or other clear liquid after taking this dose.

    Your child’s stools should be watery and clear by 10 p.m. the night before the procedure.

  4. 8 years to 18 years and older

    Two days before the barium enema

    • Give your child two 5 mg bisacodyl tablets by mouth. This pill must be swallowed. Do not let your child chew this pill.

    The day before the barium enema

    • After noon, give your child only clear liquids. This can include Pedialyte®, broth, gelatin, popsicles, and water.
    • At 2 p.m., give your child one 10-ounce (300 mL) bottle of chilled magnesium citrate to drink. Your pharmacy may have cherry syrup for you to add to this lemon-lime liquid if your child prefers that flavor. Make sure your child drinks this dose within 20 minutes. Have your child drink an 8-ounce glass of water or other clear liquid after taking this dose.
    • At 7 p.m., give your child a second 10-ounce (300 mL) bottle of the magnesium citrate to drink. Make sure your child drinks this dose within 20 minutes. Have your child drink an 8-ounce glass of water or other clear liquid after taking this dose.

    Your child’s stools should be watery and clear by 10 p.m. the night before the procedure.

What to expect during a barium enema

Here’s what you and your child can expect during the test:

  • A radiology staff member will talk with you about why your child needs a barium enema. They will explain the procedure, too.
  • The staff member will help your child onto the x-ray table. Your child will lie on his or her stomach or side. Infants and young children may use a special device to help them stay still.
  • The technologist or radiologist will insert a small tube into the rectum. There are different sizes of tubes according to size and age.
  • The technologist will use something to keep the tube in place. It might be tape or a small, inflated balloon. The tube connects to a bag containing the contrast liquid.
  • The tube will feel uncomfortable. It may make your child feel like they need to have a bowel movement. There could be some cramping. These feelings will only last a short time.
  • The radiologist will move the x-ray machine, also known as “fluoro tower,” over your child. The contrast liquid will flow through the tube.
  • The technologist will gently move your child from side to side to get good images.
  • After the test, the technologist will remove the tube and allow your child to go to the bathroom. The team may then take more images.

The test usually takes about 30 minutes.

Details to take care of before a barium enema test

These tips can help you make sure everything is in order before your child’s test:

  • You may need to talk with your insurance company to find out how much it will pay.
  • Tell the medical team about:
    • Any medications your child takes, including over-the-counter ones
    • Allergies, especially to contrast liquid (likely either contain barium or iodine)
  • Be sure your child wears loose, comfortable clothing.
  • Allow plenty of time to get to the center. You should be on-time for your appointment. It’s better to be a few minutes early.
  • Talk to your child about the test and what will happen. Child life specialists can help.
  • Bring activities in case the waiting period is long.

What to do after the test

  • After the test, be sure your child drinks extra fluids. The contrast could cause constipation.
  • At first, your child’s bowel movement may appear white or grayish if barium is used as the contrast liquid.

Getting test results

The radiologist will interpret the results and send a report to the doctor who ordered the test. A member of your child’s care team will share results at the next appointment.

Key Points

  • A contrast barium enema produces images of the large intestine.
  • A doctor may order this test if your child has problems with bowel movements, changes in bowel habits, unexplained weight loss, or stomach pain.
  • To get the best image possible, the colon must be empty.
  • Your child must prepare for a barium enema exam.
  • Follow your care team’s instructions for preparation.

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Reviewed: July 2022