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