An isthmocele (cesarean scar defect) is a pouch, or niche, that forms on the wall of your uterus. It develops if the incision from a past c-section doesn’t heal completely. Isthmocele can cause infertility or problems with future pregnancies. Laparoscopic surgery is the most common treatment for isthmocele.
An isthmocele (cesarean scar defect) is a pouch that forms in the lining of your uterus. It occurs after a cesarean birth (c-section). The pouch (also called a uterine niche) develops when the c-section incision (cut) doesn’t heal completely. Isthmoceles can lead to infertility, complications during future pregnancies and other problems.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Anyone who has a c-section can develop a cesarean scar defect. You’re at a higher risk if you:
Between 24% and 70% of people who’ve had at least one c-section develop an isthmocele. It’s becoming more common as c-section rates increase. About 30% of birthing people in the U.S. have c-sections.
A c-section involves two incisions: one in your abdomen and one in your uterus. If the incision in your uterus doesn’t heal completely or you’ve had multiple incisions in the same area, the surrounding tissue becomes thin. It can form a pouch that fills with fluid and blood.
The location of the c-section incision might affect whether you develop a scar defect. An incision that’s too low on your uterus tends to form a larger scar. Low incisions are more common when your c-section happens after you’ve been in labor for a while. A single layer of stitches to close the uterine incision (instead of a double layer) may also make isthmoceles more likely.
Yes, c-section scarring sometimes causes infertility. But with treatment, many people go on to have healthy pregnancies. Talk with your healthcare provider if you have symptoms of an isthmocele (cesarean scar defect) or if you’ve been trying to get pregnant for 12 months without success (six months if you’re over the age of 35).
Symptoms can include:
Potential complications can include:
Imaging exams are the most effective way to diagnose isthmoceles. The best time to perform imaging is right after your menstrual cycle, when the niche is likely full of blood. This makes it easier to see in images.
Your healthcare provider may perform:
There are several treatments for isthmoceles, including:
The only way to completely prevent isthmoceles is to not have a c-section. If you’re pregnant and are planning a c-section, talk to your healthcare provider about the risks of cesarean scar defects (isthmoceles). You may be able to reduce your risk by:
Cesarean scar defects (isthmoceles) are treatable. Most people can still get pregnant after cesarean scar defect treatment.
If you have an isthmocele while pregnant, you’re at risk for a ruptured uterus. This is a medical emergency. It occurs if the uterine scar separates and your uterus tears open. It can pose serious health risks to you and your baby. Seek medical attention right away if you experience severe pelvic pain, pain at the site of a c-section scar or heavy vaginal bleeding. These could be signs of a ruptured uterus.
A note from Cleveland Clinic
An isthmocele is a pouch, or niche, of tissue that forms on the wall of your uterus. It’s the result of a c-section incision that didn’t heal completely. Isthmoceles can lead to abnormal vaginal bleeding, pelvic pain and menstruation problems. It can also cause infertility or problems with future pregnancies. The most common treatment is minimally invasive surgery to remove excess scar tissue and repair the niche. Most people can still have healthy pregnancies after treatment.
Last reviewed by a Cleveland Clinic medical professional on 06/22/2022.
Learn more about our editorial process.