Isthmoceles
A uterine Isthmocele is a pouch that forms on the wall of your uterus, typically after a cesarean birth. Like any surgery or intervention, there are always going to be risks with a cesarean section. In times past, people have coined cesarean sections as “the easy way out” when, in reality, they are full-blown surgeries that require immense amounts of time for recovery and come with their own set of possible risks and complications. An Isthmocele occurs when the cesarean scar does not heal completely and can cause secondary infertility as well as abnormal bleeding. There might be other factors that can play into developing an Isthmocele, like the type of sutures used and if the sutures are done in one or two layers, but what we know for sure is that if the cesarean scar does not heal right, people are developing uterine Isthmoceles.
There are risks of developing an Isthmocele for anyone who gets a cesarean section. Still, the risks significantly increase if you are overweight, have a medical condition that delays wound healing, have had an unplanned cesarean section or emergency cesarean section, have diabetes or gestational diabetes, have had multiple cesarean sections, or smoke tobacco products. It is not sure how common Isthmocele is, but it seems to occur between 24-70% of the time for individuals who get cesarean sections. With the rising amount of cesarean sections occurring in the United States, more and more individuals are becoming at risk for developing an Isthmocele.
There are a few ways that you can tell if you might have an Isthmocele; these can include secondary infertility, which is when it was not difficult for you to get pregnant with your precious children, and now you are having immense difficulty getting pregnant with another. Abnormal periods or super painful periods can be another symptom. This could mean that your periods are much heavier and longer than typical, more painful, or that you have more than one period per monthly cycle. Pelvic pain and pain during sex are two other symptoms that could lead you to know if you are experiencing an Isthmocele, especially if these symptoms are new for you and you have not experienced them before. Lastly, more discharge or bleeding throughout the month indicates something is not quite right. Maybe you are having many of these symptoms or just one or two, or perhaps something else altogether, but if your gut tells you that you need to see your provider, listen to it. You know your body best and should trust when it asks for help.
As I mentioned above, secondary infertility is a symptom and complication that can occur for someone who is living with an Isthmocele. Other complications that can occur due to having an Isthmocele are Placenta Accreta, where the placenta develops and burrows deeply into the wall of your uterus, and Placenta Previa, where the placenta is attached over your cervix, making a vaginal birth unsafe. An Ectopic Pregnancy, when the egg implants on your previous cesarean scar, and a uterine rupture. All of these can be dangerous and make you high risk during pregnancy, so you must let your provider know.
If you have a lot of the symptoms I mentioned above, your care provider will likely want to run some diagnostic tests to make sure that you are experiencing an Isthmocele rather than something else. One of the first tests your provider might recommend is a Hysteroscopy. A Hysteroscopy is when your provider puts a blue light up through your vagina to examine your cervix and uterus for scaring and other abnormalities. Another test they might want to run is called a Saline infusion sonohysterography, which is when your provider will fill your uterus with saline and look at it with an ultrasound. Another option is called a transvaginal ultrasound, which is also an ultrasound they do when you are in early pregnancy. Still, the wand goes into your vagina and gets images for your provider to look at that way.
When it comes to treatment, there are a few options that you might be able to consider depending on the size of your Isthmocele. The first option is to take an oral contraceptive that will ideally lessen the size of your Isthmocele by regulating your period. If this is successful, there is always the chance of avoiding surgery, which would be ideal. Another option would be a Hysteroscopic Resection, when your provider does a Hysteroscopy and removes scar tissue while opening the sides of your Isthmocele, letting the fluid and blood drain out. This is a way to avoid another incision site from another surgery and will sometimes do the trick. The next best option is a Laparoscopic Repair, which is when your provider goes in Laparoscopically to remove scar tissue and drain your Isthmocele. It is non-invasive but still typically requires some recovery time. The last option, and usually the option only used when the Isthmocele is significant or not healing from other procedures, is a Hysterectomy. A Hysterectomy is when the entire uterus is removed during surgery. This would make it impossible to get pregnant again and can come with complications, but it can be a good option if you are done with having children and no other surgeries are helping with the Isthmocele.
I highly recommend talking through all of your options with your care provider and asking about the risks and benefits of each option.
The good news about Isthmoceles is that most who experience them can get pregnant again and go on to have a healthy and safe pregnancy, especially after getting the Isthmocele repaired. If you think that you might be experiencing symptoms of an Isthmocele, contact your care provider and push for diagnostic testing to confirm. It could be a life-changing choice.
