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Defecating proctogram

Your doctor has requested that you have a proctogram. We hope the following information will answer some of the questions you may have about this procedure.

What is a defecating proctogram?

It is an examination of the lower bowel and rectum using x-rays. It shows how your rectum functions during the emptying of your bowels.  The images obtained will help us understand what is causing your symptoms.  

How do I prepare for a defecating proctogram?

There is no preparation for this examination, you may eat and drink normally. Continue to take your normal medication unless otherwise instructed; however please inform us if you are allergic to anything. 

If you also have an appointment for a colonoscopy or MRI, please contact us on the number on your appointment letter as it may be necessary to delay this proctogram appointment.

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the department before attending the appointment.

On the day of the procedure

  • You will arrive at Gate 18 where a member of the Imaging team will take you through to the fluoroscopy waiting room.
  • Following confirmation of your details, you will be asked to drink two cups of diluted barium to allow us to visualise the position of your small bowel.
  • The barium takes a little time to reach your small bowel, so you will be sent away and asked to return one hour later for the main part of the examination. In this time you may eat and drink as normal and use the toilet if required.
  • On return to the main waiting area at Gate 18 a member of staff will take you to our waiting room again.
  • Before the examination starts the radiographer will check your clinical history, give a further explanation about the procedure and will try to answer any questions you may have.  You will be asked to change into a gown.
  • If you are female, a small amount of barium will be introduced into your vagina much like you would introduce a tampon. This will allow visualisation of the position of your vagina on the resultant images.
  • At the start of the examination you will be asked to lie on your side on the x-ray table whilst barium paste is introduced into your rectum via a small tube. 
  • Whilst lying down on the table, three x-ray images will be taken with you resting, squeezing and straining your pelvic floor muscles.
  • You will be helped off the x-ray table. The x-ray table is then repositioned and a portable toilet is placed onto the step in front of the x-ray table for you to sit on. At this point we would like you to try and retain the paste.
  • When the equipment is ready and you are sitting on the portable toilet the radiographer will begin to record images whilst you are asked to push out the paste until you feel empty. Do not worry if you cannot push out the paste, we will still be getting relevant and helpful information from the images obtained.
  • Finally we will take three images at rest, squeezing and straining whilst you remain seated.

The examination is performed respecting patient privacy. Please do not feel embarrassed about the procedure.  

After the examination

  • There will still be some barium retained in the bowel and your motions will appear whitish in colour for a couple of days.
  • Barium can occasionally cause constipation, so we recommend that you drink plenty of fluids afterwards. If you feel it necessary, you may take a mild laxative to get rid of the remaining barium but please seek advice from your GP or pharmacist.
  • You can eat and drink normally after the examination. Eating a high fibre diet like bran or wholemeal bread can help but the main thing is to drink plenty of fluids.
  • If you have problems with your heart or water retention, you may not be able to drink this much safely.  If in doubt or you find you become breathless or your legs swell up, contact your GP.  

What are the risks associated with a defecating proctogram?

Proctograms are generally regarded as a very safe test and problems rarely occur. Potential complications are uncommon and include:

  • We need to make you aware the barium we use for this procedure is described as “off-label”. This means the medicine has a license for investigating some conditions but the manufacturer of the medicine has not applied for a license for it to be used to investigate your condition. “Off-label” medicines are only used after careful consideration and in your case the barium is quite safe for this particular examination.
  • Pain, discomfort or a feeling of fullness when the paste is introduced. Occasionally, if pain is part of your symptoms, this pain may be replicated by this procedure.
  • Damage to the bowel wall (such as a small tear in the lining of the bowel) occurs rarely, in fewer than 1 in 2000 tests. This damage is usually minor and may not produce any symptoms.
  • Fluoroscopy involves the use of x-rays; however with modern equipment the risk is low. Your doctor has recommended this examination because he/she feels that the benefits are greater than the risk of not having the examination.

How will I get the results?

You will not get an indication of the result at the time of the examination, as analysis of the images will take place after you have left the department.

The consultant radiologist will report on your examination at the earliest opportunity and this will be sent to your consultant, who will discuss the results with you at your next appointment.

Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the x-ray department will be happy to answer them.

The telephone number for the Imaging department can be found on the appointment letter.

References

Oxford Radcliffe Hospitals NHS Trust (2012). Proctogram examination information for patients. www.ouh.nhs.uk/patient-guide/leaflets/files/78716Pproctogram.pdf

University Hospitals Bristol NHS Foundation Trust (2017). Proctograms. foi.avon.nhs.uk/download.aspx?did=3501

 

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery charges, so please contact the overseas office:

Defecating proctogram