A therapeutic enema for pediatric intussusception may benefit by using a rectal catheter with an inflated balloon. We compared the efficacy of rectal catheters without and with an inflated balloon for air and liquid enemas. We retrospectively reviewed PACS images and hospital records of children who had a therapeutic enema for intussusception at our institution between January 2006 and May 2011. Sixty-two enemas in 60 children were included. Physician assistants with training in pediatric fluoroscopy and pediatric radiologists were more likely to use air enema (37/41 or 90 %), and general radiologists were more likely to use liquid enema (18/21 or 86 %). However, the reduction rate for air enema overall was only slightly higher than for liquid enema using an inflated balloon catheter (36/40 or 90 % versus 14/17 or 82 %) (P=0.653). For air enema, mean procedure time for successful reductions was shorter with an inflated balloon catheter than with a plastic catheter (7.6 versus 28.2 min) (P<0.009), but the reduction rate was not affected. For liquid enema, the reduction rate was higher with an inflated balloon catheter than without inflation (14/17 or 82 % versus 1/5 or 20 %; P=0.021), but the procedure time was not shortened. No procedural complications were directly attributed to using a rectal catheter with an inflated balloon. Using a rectal catheter with an inflated balloon appears to safely shorten the procedure time of a successful air enema and improve the reduction rate of liquid enema.