Gastrointestinal Radiology > Procedures > Barium Enema > Types

Types of Enema

There are different types of enema:  single or double contrast barium enema and water-soluble contrast enema.

Guidelines for Choosing the Type of Enema to Perform

Indications for double contrast (air contrast) barium enema:
  • Rectal bleeding - gross or occult
  • Polyps or carcinoma - suspected or known
  • Inflammatory bowel disease - suspected or known
  • Patient over 40 years of age who can cooperate and turn over without assistance

Indications for single contrast barium enema:

  • Patient under 40 years of age with abdominal signs or symptoms not suggestive for polyps, colitis, or bleeding (i.e., pain only, bloating only) 
  • Suspected diverticulitis   
  • Bowel not prepared but limited exam requested to verify or exclude obstruction, volvulus, appendicitis, fistula, etc.   
  • Uncooperative, disabled, very old, or very ill patient unable to tolerate or perform the maneuvers required for a double contrast study

Contraindications to barium enema of any type:

  • Suspected acute perforation 
  • Acute, fulminating colitis
  • Immediately after biopsy

Indications for water-soluble contrast (Hypaque¨, Gastrografin¨) enema:

  • Suspected perforation or high risk for intestinal perforation  
  • Therapeutic enema for disimpaction (after failure of routine cleansing enemas)

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