Water-soluble contrast enema examination Patient information leaflet - The Princess Alexandra Hospital NHS Trust

Water-soluble contrast enema examination Patient information leaflet (183kB pdf)

Introduction

We hope this guide will answer your questions about your water-soluble contrast enema examination. Please contact the team if you require further information via the details at the end of this leaflet.

What is a water-soluble contrast enema examination?

A water-soluble contrast enema is an examination of your large bowel (colon) using X-rays and a contrast medium (an iodine based solution often known as X-ray dye). Normally, your bowel does not show well on X-ray on its own. The contrast medium can be seen on X-rays and is used to fill and coat the large bowel, making it visible. A small tube (catheter) is inserted into the rectum then the contrast medium is passed through this into the bowel. The test is carried out by a radiologist (a doctor who uses x-ray to diagnose and treat conditions) and a radiographer (a healthcare professional that helps facilitate the x-ray images safely). Sometimes, an assistant or a student radiographer may also be present.

What are the alternatives?

There may be alternative diagnostic tests available, such as colonoscopy, sigmoidoscopy, computed tomography (CT), or magnetic resonance imaging (MRI), among others, which come with specific advantages and drawbacks. Currently, this study has been considered the most appropriate test for you or may be part of a range of examinations needed to get a diagnosis. If you have any questions regarding what is the most fitting test for you, please speak to your referring clinical doctor to explain to you the available options.

Why do I need a videofluoroscopy assessment?

Your clinical doctor has referred you for a water-soluble contrast enema examination to help make a diagnosis or to guide further treatment plans. This test is commonly performed on people with bloating, diarrhoea/constipation, or abdominal pain, a change in bowel habit, or rectal bleeding. It may also pick up hernias, abnormal growths, and narrowing or blockages of the bowel. Your radiographer or radiologist will discuss the procedure and your symptoms as well as any concerns you may have with you. You can opt not to go ahead with the water-soluble contrast enema examination, and we will write to your referring doctor to let them know.

What are the risks?

X-Ray radiation: All x-ray procedures involve exposure to radiation in varying amounts. The dose you get from a medical x-ray is very low and your doctor has determined that the benefits of having the water-soluble enema outweigh potential risks. The radiographer is present throughout your test, making sure that the dose is kept as low as reasonably possible and the duration and level of X-rays are kept to a minimum.

Perforation: Having an enema examination means an amount of contrast is introduced into the bowel through a catheter. During this process, however unlikely, there is the possibility of making a small hole in your bowel, known as a perforation. This happens very rarely and generally is a risk only if there is a problem such as severe inflammation of the bowel wall.

Contrast: Almost all of the contrast (and air, if used) is drained at the end of your examination, with the remaining mostly passed after you visit the toilet. However, if you have a stoma, some of the contrast may collect in the bag, and you might need to change it. Once all the liquid has been passed, there should be no after effects following this procedure other than your bowel movements possibly being loose over the next few hours. There is a small possibility that you have an allergic reaction to the iodine contrast medium, if this occurs it will be treated by the team looking after you. At any point during or after the examination, if you develop itching or difficulty breathing, tell your radiographer or doctor immediately.

Patients aged 12 to 55, could you be pregnant? X-rays can be harmful to an unborn
baby and should be avoided by patients who are or may be pregnant. It is recommended that the examination is performed within 10 days of the first day of your menstrual period. If your appointment is not within this time or if you think you may be pregnant, please contact the X-ray department before your appointment. When you arrive for your test, you will be asked when your last period started. If it is more than 10 days earlier, your appointment may be postponed.

Will I need an injection?

Occasionally, patients are given a small injection of hyoscine butylbromide (Buscopan) in the arm to help relax the muscles of the stomach. After this injection, you may experience some dryness of your mouth and blurred vision. This will disappear after a few minutes and cause no ill effect.

Preparing for your procedure

No preparation is required for this examination. You may continue to eat and drink as you normally would. If this changes, you will be advised appropriately beforehand. If you are unsure or have questions about your preparation, contact your doctor or the X-ray department for advice. Please contact the booking team before your appointment if:

you are or think you may be pregnant
you have had a previous allergic reaction to contrast medium (X-ray dye) or are allergic to iodine.
you are a diabetic taking Metformin.
you have been advised or told to restrict your fluid intake.
you weigh over 30 stone/190 kilograms
you have problems standing or need a hoist to transfer
you require an interpreter – please inform us as soon as you receive your appointment letter, and we will arrange an interpreter for you

If you have a stoma (opening onto the surface of the abdomen), please bring a spare stoma bag with you just in case it is needed after the examination.

If you are unsure or have questions about your preparation, contact your doctor or the X-ray department for advice.

Allergies

If you have asthma or any allergies, especially to iodine or contrast medium (X-ray dye), please inform us in advance.

Medication

Please continue to take all medications as usual prior to your examination.

Getting to us

Once you have arrived at The Princess Alexandra Hospital (Hamstel Road, Harlow, Essex,
CM20 1QX), follow the signage to the radiology reception, which is located on the ground floor, green zone. Please let the radiology receptionist know that you have arrived for your appointment.

When should I arrive?

Please arrive in the radiology department at your given appointment time. A notification
through text or letter should have been sent to you to confirm this appointment.

Can someone stay with me in hospital?

You may have a friend or relative attend with you, but they will be asked to stay in
the waiting area while you have your procedure.
Children are not allowed in the waiting area unattended. Our staff are not permitted to
supervise children, so please ensure child care arrangements are in place to avoid your
tests being rescheduled.

The day of the procedure

You will be shown to a cubicle and asked to undress and put on a gown; please bring a dressing gown if you have one. You may also be asked to remove jewellery, dentures, glasses, or other metal objects, which may show up on the X-rays.

The procedure

Your identification will be checked by a radiographer or nurse, and a brief history will be taken; please tell the radiologist what medication, severe allergies, choking episodes, or other medical conditions you may have, such as thyroid disease and diabetes. The procedure will be explained to you. You will be asked to lie on your side on the X-ray couch, bending your knees close to your tummy. A small flexible tube (catheter) will be inserted into your back passage that has a small inflatable balloon at its tip to help retain the tube in place. Contrast will then be administered through the tube, slowly filling the bowel and coating the walls. Air may be administered too, depending on the type of enema you are having. You may feel a sense of pressure, but there should be no pain. X ray images will be taken in different stages of bowel filling, and you will be asked to change position while on the X-ray couch, which may move or tilt too. At the end of the examination, most of the contrast (and air, if used) will be drained, and after removing the tube, you will be taken to a private toilet where you can stay until you feel comfortable. Your radiographer and radiologist will be with you the whole time during the procedure and will explain what is happening or what you need to do on the day. If you have any questions or concerns, please ask.

Is it uncomfortable?

This procedure is not painful, but it can be uncomfortable and unpleasant. The test usually takes 20-40 minutes. It is recommended that you allow two hours for the examination, as you may need to use the toilet afterward.

After the procedure

Some people may feel bloated after their enema examination. However, most people have few, if any, side effects. To help clear the remaining contrast in your bowel, drink plenty of clear fluids to flush it through your system. At the end of the test, you will be able to go home immediately or when you feel ready. You can eat or drink normally and take your normal medications.

Can I drive after my procedure?

You are able to return to work as soon as discharged from the department.

How soon can I return to work?