Although bringing a baby into the world is a unique experience for every woman, certain complications may arise depending on the mode of delivery. One such condition is isthmocele—also known as a cesarean scar defect. It develops when the incision made on the lower anterior segment of the uterus during a cesarean section does not heal completely.

While isthmocele does not cause symptoms in every woman, when it does appear, it may lead to a wide range of problems—from recurrent infections and menstrual irregularities to pelvic pain and even infertility. Emphasizing that this often overlooked condition has become increasingly common due to the rising number of cesarean deliveries, Dr. Hasan Can Toyganözü, Obstetrics and Gynecology Specialist at Medline Adana Hospital, states that early detection is crucial for both women’s health and overall quality of life.

Spotting and Abnormal Bleeding May Indicate Isthmocele

Many women undergo treatment for years in different hospital departments due to various complaints, yet the underlying cause—an isthmocele—may remain unrecognized. When the cesarean incision does not heal properly, a small pouch-like defect may form at the site, causing menstrual blood to accumulate in this area. This can lead to persistent spotting, prolonged menstrual periods, or post-coital bleeding—symptoms whose underlying cause isthmocele may be.

It May Also Affect Fertility

Beyond spotting, the condition may manifest as chronic lower abdominal pain, a feeling of pressure in the pelvis, recurrent vaginal infections, and excessively long menstrual cycles. Recent studies indicate that in some women, isthmocele can make achieving pregnancy more difficult and may even increase the risk of ectopic pregnancy. For this reason, women experiencing these symptoms—particularly those with menstrual irregularities or long-lasting spotting—should be evaluated for the possibility of isthmocele.

Diagnosis Is Relatively Easy

The diagnostic process is generally straightforward. The initial evaluation typically includes a gynecological examination and ultrasound imaging. Transvaginal ultrasound, in particular, provides rapid information regarding the shape, depth, and size of the isthmocele. When necessary, more advanced techniques—such as hysteroscopy—may also be used to obtain a clearer assessment.

Treatment Options Vary

Treatment of isthmocele depends on the severity of symptoms and whether the patient is planning a future pregnancy. In mild cases, medical therapy may help regulate abnormal bleeding; however, because the issue is structural, surgical intervention often yields more effective results. Among surgical approaches, the most commonly preferred method is hysteroscopic repair, in which the defect is corrected by entering the uterine cavity through the vaginal route. For patients with more advanced defects or significantly reduced myometrial thickness, laparoscopic (minimally invasive) surgery may be considered as an alternative.