Is a Colon X-ray Necessary After a Normal Colonoscopy?

Colonoscopy examination

Hello Doctor: In July and August, I experienced pain in the lower left abdomen and noticed mucus in my stool, so I scheduled a colonoscopy in September, which returned normal results.
However, I still have changes in bowel habits, diarrhea, borborygmi, and swelling on the left side of my abdomen.
In October, I visited another hospital and consulted both the hepatobiliary and gastroenterology department and the colorectal surgery department on the same day.
The gastroenterologist felt there was no major issue since I had undergone both a colonoscopy and gynecological examination, both of which were normal.
However, the colorectal surgeon arranged for a barium enema, stating that it can observe intestinal motility and suspected irritable bowel syndrome.
I would like to ask if it is still necessary to have a barium enema after having a colonoscopy? Thank you for your clarification.

Shan Shan, 30~39 year old female. Ask Date: 2016/10/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Miss.
There is no need to discuss medication further with the physician.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2016/10/07

More Info

When it comes to gastrointestinal issues, particularly those involving the colon, the decision to undergo additional imaging or diagnostic tests can often be complex and dependent on various factors. In your case, you have already undergone a colonoscopy, which is a direct and highly effective method for visualizing the interior of the colon and rectum. The results of your colonoscopy were normal, yet you continue to experience symptoms such as changes in bowel habits, diarrhea, abdominal noises, and localized swelling in the left side of your abdomen.

The question of whether a colon X-ray (specifically a barium enema or colon X-ray) is necessary after a normal colonoscopy is a valid one. Here are some points to consider:
1. Purpose of the Tests: A colonoscopy allows for direct visualization and intervention (such as polyp removal) within the colon. It is generally considered the gold standard for colorectal examination. A colon X-ray, particularly a barium enema, can provide information about the motility of the colon and can help identify structural abnormalities that may not be visible during a colonoscopy. However, it is less sensitive than a colonoscopy for detecting polyps or early-stage cancers.

2. Symptoms and Differential Diagnosis: Your ongoing symptoms could be indicative of several conditions, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or functional gastrointestinal disorders. Since the gastroenterologist you consulted suggested that your symptoms might be related to IBS, further imaging could help rule out other potential causes or complications.
3. Medical Judgment: The recommendation from the rectal surgeon to undergo a colon X-ray may be based on their clinical judgment that additional imaging could provide further insights into your symptoms. They may be looking for issues related to bowel motility or other structural concerns that could explain your ongoing symptoms.

4. Risks and Benefits: While additional imaging can provide more information, it is essential to weigh the risks (such as exposure to radiation) against the potential benefits. If your symptoms are significantly impacting your quality of life or if there is a concern for a more serious underlying condition, the benefits of further investigation may outweigh the risks.

5. Follow-Up and Monitoring: If you decide to proceed with the colon X-ray, it is crucial to maintain open communication with your healthcare providers. They can help interpret the results and guide you on the next steps based on the findings. If the X-ray is normal and your symptoms persist, further evaluation may be warranted, which could include dietary changes, medication for symptom management, or even referral to a specialist in functional gastrointestinal disorders.

In conclusion, while a normal colonoscopy is reassuring, your ongoing symptoms warrant further investigation. A colon X-ray may provide additional information that could help clarify the cause of your symptoms. It is advisable to discuss your concerns and the necessity of the X-ray with your healthcare provider, who can provide personalized recommendations based on your specific situation. Remember, the goal is to ensure that you receive the most appropriate care tailored to your needs.

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