C-section Niche
A C-section niche is a small pouch in the uterus wall where a previous caesarean scar has not healed fully. Also called an isthmocoele, it can collect menstrual blood, causing spotting after periods, pelvic pain or, sometimes, difficulty conceiving. Many women have no symptoms, and treatment is only needed if the niche causes problems.
Commonality
Causes
Symptoms
Not all scar defects cause symptoms, but when they do, common signs include:
Brown or prolonged spotting after periods
Irregular bleeding
Pelvic pain
Pain during periods
Pain during ovulation
Discomfort during intercourse
Secondary infertility
If you have ongoing symptoms after a caesarean birth, a scar niche may be worth investigating.
Effects on Fertility
In some women, fluid collecting within the scar defect may affect the uterine environment and make implantation more difficult. A niche can also be associated with abnormal bleeding patterns that point to poor healing of the uterine scar.
For women trying to conceive, accurate diagnosis and appropriate treatment may improve symptoms and support future pregnancy planning.
Diagnosis
Diagnosis starts with a detailed review of your symptoms, menstrual history and previous caesarean section.
Investigations may include:
Transvaginal ultrasound
Saline infusion scan
MRI scan in selected cases
These tests help assess the size and depth of the defect and the thickness of the remaining uterine muscle.
Treatments
Treatment depends on your symptoms, the size of the defect, and whether you are planning future pregnancy.
For symptomatic women, surgical repair of the C-section scar niche may be recommended. This aims to remove weak scar tissue and reconstruct the uterine wall to create a smoother, stronger contour.