A barium enema is an investigative procedure undertaken to determine the reasons behind bowel problems such as bowel (aka colorectal) cancer, which is the third most common cancer in the UK. With a 40% survival rate, bowel cancer is the second biggest killer after lung cancer. Men are slightly more likely to be affected than women. Around 34,000 people in the UK contract colorectal cancer each year; compared with just under 38,000 for breast cancer and more than 38,000 for lung cancer, the biggest killer, with only a 5% survival rate¹. Risk factors include a strong family history, and poor diet. Treatment involves surgery plus chemotherapy. Radiotherapy plus surgery is required for cancer of the rectum.

A barium enema consists of an insoluble compound known as barium sulphate which is introduced into the lower intestinal tract. Barium sulphate absorbs X-Rays much more readily than human tissue, thus providing a high-contrast outline of the colon and rectum that allows the doctor to examine the structure of the lower intestinal tract. This is the same principle as applies with a barium meal, which is taken orally to examine the upper intestinal tract: for example the oesophagus, stomach and small intestine. It is usually ordered by a GP if someone (hereafter called 'the patient') reports to him with any or all of the following symptoms:

• Any change in pattern or type of bowel movement
• Bleeding during/after bowel movement
• Bleeding from the anus
• Stomach cramps, usually before bowel movement
• Abdominal pain
• Any abnormalities flagged up by previous investigations (such as a colonoscopy or an ultrasound scan)

Someday there may be an equally effective but less invasive means of checking for a diseased colon, but not yet. With this test they will know exactly what they are dealing with and will be able to plan the follow-up measures accordingly.

Before the Procedure

The patient will receive a letter from the hospital clinic confirming their appointment, and a supply of laxative to ensure their bowels are emptied. The instructions to make up and take the laxative should be followed exactly: it's advisable not to plan for any meals after ingestion of the laxative. Certainly the patient shouldn't venture too far from the vicinity of a toilet. Plenty of water will need to be drunk because the laxative will cause dehydration. It will be requested that the patient abstain from eating some foods like red meat, which take a long time to digest, several days beforehand, and may even be required to go on a liquid-only diet prior to the procedure.

If the patient is on any medication they should inform the clinic, as some types may have to be discontinued before the procedure, and the medicine in the original packaging should be shown to the staff at the clinic. The clinic appointment letter will have a telephone number if the patient wishes to phone and ask for advice.

Take an old towel with you (to sit on), sanitary towels and a change of underwear in case of accidents. You'll also need to keep sipping from a bottle of water to ensure your fluid levels are topped up.

You may get helpful feedback if you tell your friends. Virtually everyone knows somebody who's had the procedure, and you will have moral support and lots of sympathy.

Having the Procedure

You must tell the medical staff if you are pregnant, or if there is a possibility that you might be pregnant. You will be asked to sign a consent form which states that you have confirmed this.

In the examining room the patient will be asked to lie on a bed or couch on their side with knees bent, in the foetal position. No anaesthetic is administered, due to the patient having to move around on the table. The doctor inserts a tube into the anus, which is then taped into place. A cold suspension of barium sulphate is then pumped in, and X-Rays are taken.

As the patient is awake, they are invited to watch the procedure onscreen, but this isn't compulsory. The doctor will look at the X-Rays of the colon, which measures four to five feet in length. The procedure takes about an hour.

Afterwards

The patient should expect to be flatulent for some time, due to the air (used to inflate the colon during the procedure) needing an avenue of escape. The clearing of the bowels flushes out all of the good bacteria in the digestive system, so it's a good idea to eat pro-biotic yoghurts and such for a week or so afterwards, to restore those bacteria. You will hear from the hospital clinic informing you when to go back for the results of your test, and any further treatment.

Advice for the over-50s

Age is a factor. If you are over the age of 50 your doctor will probably recommend a colonoscopy routinely. However, for some individuals the risks involved in having a colonoscopy, such as the risk from anaesthesia, can outweigh the benefits, and in these cases a barium enema may be more suitable. The American Cancer Society recommends that everyone has a test for colon cancer at age 50. However, a quarter of people surveyed say their doctor had never discussed colon cancer screening with them, and another quarter said they didn't get screened because they had no symptoms of the disease. Considering colon cancer is the second largest cause of cancer-related death in the US, and bowel cancer is the third most common type of cancer in the UK, it would be prudent not to wait until you do have symptoms, but get yourself checked out anyway. Early detection provides a greater chance of fighting and beating the disease. Those with a family history of the disease shouldn't wait until they're 50.

Look After Yourself

This is such an important examination that you ought to consider having a barium enema even if you have to pay for it yourself. Having a clean bill of health can give you a whole new outlook on life. Thanks to early investigation and diagnosis, nine out of ten cases of colon cancer respond to treatment, enabling the patient to have a better prognosis and quality of life.

Prevention is better than cure. While cancer cannot be foreseen and can strike anyone at anytime, colorectal cancer is 100% preventable, the key to this being diet. In particular, a balanced diet with plenty of roughage (fibre) is recommended to ensure regular bowel movements. The UK Department of Health has stated that one needs between 12-20g of dietary fibre per day, and more if one is prone to constipation. People with chronic constipation have an almost 80% greater chance of colorectal cancer than those who have regular bowel movements. Furthermore, studies have indicated that an intake of 35g of fibre a day can reduce the chance of bowel cancer by up to 40%. Drink lots of water (up to two and a half litres/four pints, but obviously not all at once) a day to maintain your organs in tip-top condition.

A study showed that women who were taking the RDA (Recommended Daily Allowance) of Folic Acid and Vitamin B6 had a 70% less likely chance of colon cancer. Folic Acid is present in dark green leafy vegetables like spinach, whole wheat flour, carrots, eggs, yeast and liver. Folic Acid should be taken as a dietary supplement before and during pregnancy. Pyridoxine (vitamin B6), like the rest of the Vitamin B complex, is found in fruits and vegetables, yeast, beef, the dairy products milk, cheese and eggs, and also beer. It is also found in liver but this offal is not recommended for consumption by pregnant women. People who are lactose intolerant or who have special dietary requirements need to take further advice from their health care provider.

Please Note: h2g2 is not a definitive medical resource. If you have any health concerns you must always seek advice from your local GP. You can also visit NHS Direct or BBC Health Conditions.