Endometrial tissue is the inner lining inside of the uterus. It’s meant to support pregnancy. It also sheds itself on a monthly basis while you have your period.
People who have endometrial-like tissue in other places in their bodies have a condition called endometriosis. Examples of where this tissue can grow include the:
- abdominal wall
While very rare, it’s possible that endometrial-like tissue can grow in the incision site of a woman’s stomach after a cesarean delivery. This happens infrequently, so doctors may misdiagnose the condition after pregnancy.
If the tissue grows outside of the walls of the uterus from the abdominal wall cesarean incision, it’s called endometriosis, but if it grows within the walls of the uterus at the uterine cesarean incision scar, it’s referred to as adenomyosis.
Some of the symptoms of these conditions overlap, including painful periods and pelvic pain.
The most common symptom of endometriosis and adenomyosis after a cesarean delivery is pelvic pain. Another common symptom is the formation of a mass or lump in the surgical scar. The lump can vary in size and can be painful.
Some people may notice that the mass is discolored, and it can even bleed. This can be confusing after giving birth, and may occur much later after delivery. It may look like the incision hasn’t healed well, or that excess scar tissue is forming. Some people don’t experience symptoms other than a noticeable mass at the incision site.
The endometrium is meant to shed with a person’s menstrual cycle if they are not pregnant. Endometrial-like tissue acts in the same way and may also bleed. But not all people notice bleeding that’s related to their cycles.
Is it endometriosis?
Other conditions doctors often consider in addition to endometriosis after a cesarean delivery include:
- incisional hernia
- soft tissue tumor
- suture granuloma
It’s important that a doctor consider endometriosis as a possible cause of the pain, bleeding, and mass at the cesarean delivery incision site.
A doctor may have to do several tests before they suspect endometriosis. Sometimes a person may have surgery to remove the lumpy area before a doctor ever identifies the bump as having endometrial-like tissue.
The only definitive method to diagnose endometriosis is to take a sample of the tissue. A doctor who specializes in pathology (the study of tissues) will look at the sample under a microscope to see if the cells resemble those in the endometrial tissue.
Though imaging tests such as a CT scan or MRI are not useful in diagnosing endometrial-like tissue in a cesarean scar, doctors may use them to rule out other possible causes of the mass or tumor in the abdomen. The only way to know is to take a biopsy of the suspected endometrial-like cells.
Treatment for endometriosis usually depends on your symptoms. If your discomfort is mild and/or the area of endometriosis is small, you may not want invasive treatments. You could take an over-the-counter pain reliever, such as ibuprofen, when the affected area bothers you.
Doctors usually treat endometriosis with medications. Examples include hormonal birth control pills. These control hormones that cause bleeding.
Will you need surgery?
Medications may not work for all surgical scar endometriosis.
Instead, a doctor may recommend surgery. A surgeon will remove the area where the endometrial-like cells have grown, plus a small portion around the incision site, to make sure all the cells are gone.
A doctor should discuss the surgical approach with you. Take your time to make the best and safest decision for you. You may even wish to get a second opinion.
After surgery, the chances that endometriosis will come back are small. People who choose surgery have a recurrence rate of 4.3 percent.
If you notice a painful area of scar tissue after a cesarean delivery, talk with your doctor. While there are several potential causes for this, pay attention to your symptoms and if they get worse when you’re on your period. This could mean that endometriosis is the cause.
If your symptoms are painful, discuss treatment options with your doctor.
If you plan to have another c-section in subsequent pregnancies, discuss risks of a recurrence with your doctor.