Almost nobody says it out loud to a doctor. They say it to themselves, in a bathroom, at seven in the morning: it’s only piles. Then they get on with the day, and say it again three weeks later.
Piles usually are the answer. Haemorrhoids are extraordinarily common, not dangerous, and most settle within days. But “usually” is doing a great deal of work in that sentence, and the people it fails are disproportionately over 50. The aim here is to separate two things that get tangled together: treating piles well, and never letting piles become the explanation you gave yourself instead of the one a doctor gave you.
TL;DR
- Piles (haemorrhoids) are swollen blood vessels in and around the back passage: very common, usually settling in days, and responsive to fibre, fluids and pharmacy treatments.
- HSE advice is unambiguous: contact your GP about any bleeding from your bottom. Having piles rules nothing else out.
- Bowel cancer is Ireland’s second most common cancer: over 2,500 diagnoses a year, a median age at diagnosis of 70 to 74, more than 90% of cases in people over 50, and around 60% found at a late stage.
- Under the National Cancer Control Programme referral pathway, rectal bleeding lasting more than six weeks is “persistent” and warrants an urgent referral. Urgent colonoscopy referrals are offered an appointment within four weeks where possible.
- BowelScreen (ages 57 to 71 since 1 April 2026) is for people with no symptoms. A clear screening result from last year does not explain bleeding this year. Do not wait for the next kit.
- Non-stop bleeding, heavy bleeding or severe pain is a 112 or 999 call, not a GP appointment.
What piles actually are
Haemorrhoids are swollen blood vessels that form lumps inside or around the anus, anything from pea-sized to the size of a grape. They may itch, ache, make sitting uncomfortable, or leave bright red blood on the paper or streaked on the stool. Most clear up in days without treatment.
The HSE is honest that the cause is not fully understood, but the associations are clear enough to act on: constipation, straining, heavy lifting and pregnancy. After 50 the first two matter more than people expect, because slower transit, less fibre and fluid, and constipating medicines (opioid painkillers, iron tablets, some blood pressure drugs) quietly change what happens in the bathroom. Piles are often the visible end of a constipation problem nobody has dealt with.
Why the assumption is the risk, not the piles
The trap is logical rather than medical. Piles are common. Bowel cancer is also common, and becomes more so with every decade after 50. Having one does not protect you from the other: a person can have textbook haemorrhoids and a tumour higher up at the same time. The haemorrhoids then provide a ready-made, reassuring, entirely wrong explanation for the bleeding, and absorb months of delay while doing it.
The numbers are worth sitting with. The NCCP’s referral pathway, drawing on National Cancer Registry data, records over 2,500 colorectal cancer diagnoses a year in Ireland, roughly 1,500 in men and 1,000 in women. The median age at diagnosis is 70 to 74, more than 90% of people are over 50 when diagnosed, and around 60% are found at a late stage. Five-year survival is 62.6%, and stage at diagnosis is the biggest lever any of us can pull on that number.
None of this makes bleeding likely to be cancer. It makes bleeding worth twenty minutes of a GP’s time, which is a very different claim.
What your GP will actually do
Far less than people dread, and it is over quickly. Expect questions about the pattern and colour of the bleeding, whether your bowel habit has changed and for how long, plus any weight loss, tiredness or family history. Expect a digital rectal examination, which takes seconds, and a full blood count, because the NCCP pathway asks for an FBC on every referral: slow, silent blood loss shows up as iron deficiency anaemia long before anyone notices anything in the toilet bowl.
The thresholds are specific, and knowing them helps you understand the decision rather than second-guess it. Persistent rectal bleeding, defined as lasting more than six weeks, warrants urgent referral. Direct referral to endoscopy applies from age 60 with persistent bleeding, a change in bowel habit lasting more than six weeks, or unexplained significant weight loss alongside other suggestive symptoms. From age 40 it applies where bleeding and a changed bowel habit of more than six weeks occur together. Under 40, a significant family history is needed as well. Unexplained iron deficiency anaemia is a trigger in its own right, at a haemoglobin of 11g/100ml or below in men and 10g/100ml or below in women who are no longer menstruating.
Two details are worth carrying with you. A normal rectal examination does not remove the need to refer, so do not accept “I felt nothing, off you go” as the end of the story if symptoms persist. And anal symptoms on their own (prolapsed piles, a fissure, rectal prolapse) are not generally sent straight to endoscopy, which is the pathway working as designed rather than your GP dismissing you. Urgent colonoscopy referrals are offered an appointment within four weeks where possible; routine referrals run at roughly 13 weeks.
BowelScreen does not answer a symptom
This is the misunderstanding that costs the most time. Since 1 April 2026 BowelScreen invites everyone aged 57 to 71, a free home FIT kit every two years, and it works: for every 1,000 people who complete the test, around 40 go on to colonoscopy at one of 16 participating endoscopy units. The programme is extending in stages towards ages 55 to 74 by 2030, with a further extension down to age 50 approved in April 2026.
But screening is designed for people with no symptoms. It is a population net, not a diagnosis. A normal FIT result eighteen months ago tells you nothing about bleeding that started last month, and the answer to a new symptom is never “I’ll mention it when the next kit arrives”. If you are bleeding, you are not a screening candidate for that question. You are a patient with a symptom, and there is a faster door for that.
When it is not a GP appointment at all
Phone 112 or 999, or go to your nearest emergency department, if you are bleeding non-stop, bleeding heavily (the toilet water turns red, or you are passing large clots), or in severe pain. Ask for an urgent GP appointment if you have piles along with a high temperature, feeling hot and shivery and generally unwell, or pus leaking from the area, all of which suggest infection rather than simple haemorrhoids.
Treating piles properly in the meantime
Assuming your GP has looked and is satisfied, the treatment is unglamorous and effective. Keep stools soft with fibre and fluids, which does more than any cream. Do not strain, and do not spend longer on the toilet than the job requires; reading in there is a genuine risk factor. Do not take ibuprofen if your piles are bleeding. A pharmacist can advise on creams, stool softeners and cold packs, and you can ask to speak in a private area. Everyone aged 70 and over holds at least a GP visit card, so the consultation need not be a cost barrier.
If home measures fail, hospital options are day-case and done while you are awake with the area numbed: rubber band ligation, sclerotherapy, electrotherapy or infrared coagulation. Surgery is reserved for piles that do not respond, and no treatment guarantees they will not return, which is why the fibre and fluids part is not optional.
The real obstacle is embarrassment
A generation of Irish people were raised not to discuss anything below the waist, and that reticence costs time nobody can afford to lose. Your GP has examined thousands of bottoms and finds yours no more remarkable than an ear. Thirty seconds of awkwardness buys you either a straightforward diagnosis and a tube of cream, or the earliest possible start on something that rewards early starts.
If you take one thing from this: piles are a diagnosis a doctor gives you, not one you give yourself. At Críonna Health we return to that distinction often, because so much of ageing well in Ireland comes down to which symptoms you decide are worth a phone call. This one always is.
This article is general information, not medical advice. If you have bleeding from your bottom, a change in bowel habit lasting more than a few weeks, or unexplained weight loss, contact your GP. HSE Live is on 1800 700 700.
📷 Photo by Age Cymru on Unsplash
