Contrast Enema

What is a contrast enema?

A contrast enema is an X-ray study that allows us to examine the colon (large bowel). As part of the exam we fill the bowel with a liquid “contrast agent” containing barium or iodine, X-ray absorbing materials that appears white on X-ray film. When the bowel is filled with contrast any abnormalities in its structure become visible on an X-ray. Doctors often request this exam to help diagnose a condition in:

  • Babies who have difficulty passing meconium (early infant bowel movements)
  • Infants with constipation
  • Children who are bleeding from the rectum
  • Children with a history of necrotizing enterocolitis (NEC)
  • Children who have had prior bowel surgery

A contrast enema is a fluoroscopy exam. This type of X-ray imaging enables doctors to capture a real-time, moving image of your child’s bowel, much like an X-ray movie. To make this image we use a specialized X-ray machine called a fluoroscope. The fluoroscope directs an X-ray beam at the bowel, and captures the image created as the X-rays are absorbed or scattered by the internal organs and tissues.

How should I help my child get ready for the test?

Most children will not need any special preparation before a contrast enema, although those who are being examined because there is bleeding from the rectum will need to clear the bowel before the exam. Your doctor will give you instructions on how to do this by giving your child either a liquid to drink or a cleansing enema.

On the day of the test your child should wear comfortable clothes and will be asked to change into a gown when you arrive at the fluoroscopy site.

What will happen during the test?

During the exam we will ask your child to lie on a table below the fluoroscope. Before the imaging begins we will insert a very small flexible tube into your child’s rectum. We will then fill your child’s bowel with contrast material through this tube. We may ask your child to turn from side to side and from stomach to back to help move the contrast through the bowel. This enables us to view its size, shape, and contours more easily.

Your child may develop mild, crampy abdominal pain, and will feel the need to move his/her bowels, but will be instructed to “hold it” until the test is completed. After we have finished imaging his/her bowel, we’ll remove the tube, and ask your child to go to the bathroom or put a diaper on him/her until he has a bowel movement. We may take additional pictures after the bowel movement.

How can I help my child feel comfortable about and during the test?

Young children sometimes find the fluoroscope, a large machine that passes over the X-ray table, a bit frightening. A doctor will remain in the room with your child explaining the procedure every step of the way.

You can remain with your child in the imaging area during the exam to offer comfort and reassurance and will be asked to wear a lead apron to protect you from unnecessary exposure to radiation. We can also arrange to have a child life specialist at your child's appointment to help your child better cope with the stress of the procedure.

Are there any risks?

Although this is an X-ray based exam, your child will be exposed to minimal doses of diagnostic radiation.

Sometimes children have a mild adverse reaction to the contrast agent, which can include stomach cramps, diarrhea, or constipation. A very small number of people are allergic to the contrast agent, and develop allergy symptoms (hives, itching, red skin); severe allergic reactions are very uncommon, and we are well-equipped to deal with them. Very rarely the test causes a perforation of the bowel that requires urgent surgery.

After the test

After the exam your child can immediately resume his/her normal activities.

A radiologist will analyze the fluoroscopic images and will share the results with the doctor who requested the exam. Your child’s doctor will then discuss the results with you.