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 β 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 β 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.
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.
Dr Cillian Keogh's clinic in Dublin 2, where the electrotherapy is carried out
The non-surgical electrotherapy treatment discussed throughout the episode
Ireland's national bowel screening programme
04:19 β What a haemorrhoid actually is
04:58 β Who is most at risk
05:12 β The newest risk group: phones on the toilet
08:33 β Anusol, Preparation H and the limits of creams
09:19 β Where electrotherapy sits on the treatment ladder
10:05 β The haemorrhoidectomy, and why you want to avoid it
11:40 β βThe last taboo of healthcareβ
17:54 β What applying an electric current actually does
24:06 β Bleeding, bowel cancer and when to get checked
29:01 β The privilege of being let into people's lives
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