Most People Don't Need Surgery for Haemorrhoids with Dr Cillian Keogh #188

Laura is joined by Dr Cillian Keogh, a GP and co-founder of Dublin City Clinic, for a frank and surprisingly funny conversation about haemorrhoids — what they actually are, who gets them, and why almost nobody wants to say the word out loud.

Cillian explains that haemorrhoids are anal cushions that swell under increased pelvic pressure, and goes through who is most at risk: pregnancy, obesity, chronic coughs, straining, long hours sitting and heavy lifting in the gym. He also describes a newer group he sees far more of now, people staying on the toilet much longer than they need to because their phone is in their hand.

From there, he walks the treatment ladder. Creams like Anusol and Preparation H settle a flare-up but, in his words, only paper over it. At the far end sits the haemorrhoidectomy, a hospital operation with weeks of recovery — the thing he says, with his GP hat on, you want to avoid. In between is the electrotherapy his clinic offers, where a small current constricts the blood vessel feeding the haemorrhoid so it shrinks, with no real downtime.

Underneath it all is why the episode matters. Haemorrhoids are, as Cillian puts it, the last taboo of healthcare, and people live with them for years rather than mention them. He also makes the case, carefully, that bleeding is worth having looked at rather than assumed.

🔑 Key Points

Haemorrhoids are not a growth, they are cushions under pressure

Cillian describes them as anal cushions that become engorged and swollen when pelvic pressure rises, which is where the bleeding comes from.

Almost everything that causes them works the same way

Pregnancy, obesity, chronic coughs, straining, long hours driving and heavy lifting in the gym all raise pelvic pressure.

Phones on the toilet are a genuinely new risk factor

Cillian sees a group he did not see ten years ago, people sitting far longer than they need to because they are still reading the headlines or scrolling.

They can sit there silently for years

Internal haemorrhoids often go unnoticed until a flare-up, while thrombosed ones stay permanently outside, lose their blood flow and come close to a medical emergency.

Creams and suppositories only paper over the problem

Anusol, Preparation H and the prescription versions settle a flare-up without treating the cause, and once you have had them the threshold for getting them again drops.

The operation is the thing worth avoiding

A haemorrhoidectomy means a general anaesthetic, a hospital stay and weeks lying on your front, which is exactly why Cillian would rather catch it earlier.

Electrotherapy sits in the gap between creams and surgery

A small electric current constricts the blood vessel feeding the haemorrhoid so the tissue shrinks over a few weeks, and you go back to work the same day.

The real barrier is embarrassment, not treatment

Cillian calls it the last taboo of healthcare, because people cannot imagine raising it without being met with an eye roll.

📚 Resources

Dublin City Clinic

Dr Cillian Keogh's clinic in Dublin 2, where the electrotherapy is carried out

eXroid

The non-surgical electrotherapy treatment discussed throughout the episode

BowelScreen

Ireland's national bowel screening programme

⏱️ Timestamps

04:19 — What a haemorrhoid actually is

04:58 — Who is most at risk

05:12 — The newest risk group: phones on the toilet

08:33 — Anusol, Preparation H and the limits of creams

09:19 — Where electrotherapy sits on the treatment ladder

10:05 — The haemorrhoidectomy, and why you want to avoid it

11:40 — “The last taboo of healthcare”

17:54 — What applying an electric current actually does

24:06 — Bleeding, bowel cancer and when to get checked

29:01 — The privilege of being let into people's lives

Thanks for listening! You can watch the full episode on YouTube here. Don’t forget to follow The Laura Dowling Experience podcast on Instagram @lauradowlingexperience for updates and more information. You can also follow our host, Laura Dowling, @fabulouspharmacist for more insights and tips. If you enjoyed this episode, please subscribe and leave a review—it really helps us out! Stay tuned for more great conversations.

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