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

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The Laura Dowling Experience 38 min 1 speaker 8 chapters transcribed

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What exactly are haemorrhoids and how do they form?

Laura Dowling 0:00

I'd say talking about bum holes for an hour to do is shouldn't it? Welcome back to the Lower Down Experience podcast, where each week I bring you insightful and inspiring guests that will open your mind and empower your life. Quick favour before we start, if you're enjoying this podcast, rate it or share it with a friend. That's how we keep it growing. Hi, it's Laura. If you've been listening to this podcast for a while, you'll know that I'm a big believer in looking after your health before something goes wrong. That's one of the reasons why I'm delighted to partner with Level Health, today's sponsor. Looking after your health isn't just about what happens when you're unwell. It's about having the right support when you need it.

Laura Dowling 0:49

That's exactly what Level Health is about. They're backed by Aviva and already Ireland's fastest growing health insurance provider. But what really stands out is how simple they've made everything. You get better access to scans and urgent care clinics, and you can speak to your doctor twenty-four seven through video and WhatsApp consultations, which is so reassuring when something goes wrong. Through their partnership with Randox Health, members can access discounted health screenings to help better understand your health and hormones from the comfort of your own home. So maybe it's time to choose health insurance that's designed to help you stay well. Not just cover you when you're sick. Visit levelhealth.ie to find out more.

Laura Dowling 1:30

24-7 unlimited access to doctors via Quick Clinic is included on plans A to E. Level Health Limited, trading as Level Health, is regulated by the Central Bank of Ireland. Health insurance provided by Level Health Limited is underwritten by Aviva Insurance Ireland DAC. Now enjoy the podcast.

Unknown 1:50

No.

Laura Dowling 1:53

Killian, welcome to the podcast. Hello, Laura.

Dr Cillian Keogh 1:55

Thanks so much for having me.

Laura Dowling 1:57

We are talking all about hemorrhoids today.

Dr Cillian Keogh 1:59

Yeah, real sexy stuff.

Laura Dowling 2:00

What a fascinating topic. However, it is something that a lot of people suffer from, need help with. So we're gonna dive deep into it. Excuse the pun. So first of all, tell us What you do, and we'll go from there.

Dr Cillian Keogh 2:16

My background is GP. Myself and my partner, Fergal McNamara, were based in Pierce Street. And what happened was maybe about four or five years ago, we noticed that there was a a dirt disservices between the ointments and suppositories that people were getting intermittently to kind of calm down a flare-up of uh hemorrhoids. And then the other aspect was the hospitals and the hospitals are needed for hemorrhoid treatments, but they can be scary. There can be reasons why people don't want to go into them really to get their treatment.

Laura Dowling 2:48

And it can be a big deal. Absolutely.

Dr Cillian Keogh 2:50

Like I mean, you can have people who goes to severe hemorrhages. Everyone knows they're kinda the butt of the joke again, excuse the point. I think I feel like there'll be a few of them. God. It's all God. But uh I think it the people know that they're kind of like they're nothing significant, but they aren't significant until they are really in people's lives. You know, if you're having daily bleeding and daily pain and every time you go to the toilet is an ordeal, then it takes over your life, you know? So anyway, going back to our story was that we encountered about over the course of about a month or six weeks, we noticed that there was a few of these people who were following Fall in between the cracks.

Dr Cillian Keogh 3:28

Okay, this lens itself, I realize now. Right. But we we kind of then did our own research and looked up what other services are available in the community base. And we noticed that there was a service in England and the UK called Xroid. And essentially we reached out to them and said, Look, we are interested in this or we've read a bit about it. Can we get more detail? We went over, saw their data first of all. They'd been doing it over there for about the guts of about Ten years? Okay. They had loads of patient detail and loads of patient data and we were like, Okay, this looks pretty legit and good solution to this problem and then we went over, trained up and brought it back.

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Chapters

8 chapters

1 What exactly are haemorrhoids and how do they form? 0:00–5:46 2 Who is most at risk for developing haemorrhoids? 5:46–10:44 3 How does modern smartphone use on the toilet increase haemorrhoid risk? 10:44–15:07 4 What are the pros and cons of over‑the‑counter creams like Anusol and Preparation H? 15:07–19:15 5 Where does electro‑therapy fit on the haemorrhoid treatment ladder? 19:15–24:13 6 Why should patients try to avoid a haemorrhoidectomy and what does it involve? 24:13–29:20 7 How can you tell if bleeding is from haemorrhoids or something more serious? 29:20–32:58 8 What should patients expect in cost, recovery time and follow‑up after electro‑therapy? 32:58–38:10

Speakers

1 identified

Laura Dowling 8 min

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Recorded24 Sep 2026

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Show notes

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 PointsHaemorrhoids are not a growth, they are cushions under pressureCillian 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 wayPregnancy, 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 factorCillian 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 yearsInternal 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 problemAnusol, 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 avoidingA 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 surgeryA 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 treatmentCillian calls it the last taboo of healthcare, because people cannot imagine raising it without being met with an eye roll.📚 ResourcesDublin City ClinicDr Cillian Keogh's clinic in Dublin 2, where the electrotherapy is carried outeXroidThe non-surgical electrotherapy treatment discussed throughout the episodeBowelScreenIreland's national bowel screening programme⏱️ Timestamps04:19 — What a haemorrhoid actually is04:58 — Who is most at risk05:12 — The newest risk group: phones on the toilet08:33 — Anusol, Preparation H and the limits of creams09:19 — Where electrotherapy sits on the treatment ladder10:05 — The haemorrhoidectomy, and why you want to avoid it11:40 — “The last taboo of healthcare”17:54 — What applying an electric current actually does24:06 — Bleeding, bowel cancer and when to get checked29:01 — The privilege of being let into people's livesThanks 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. Hosted on Acast. See acast.com/privacy for more information.

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