Can I Get Endometriosis After a C-Section?

An Uncommon Development on the C-Section Scar

Cesarean section (C-section) scar endometriosis is rare and difficult to diagnose, but it is treatable. Endometriosis is a condition in which endometrial-like tissue grows outside the uterus. It spreads within the pelvis and sometimes develops in the skin of a C-section scar. 

Endometriosis affects about 2% to 10% of the female population. Only about 0.03% to 0.4% endometriosis cases involve a C-section scar. However, some research suggests that this rate may rise along with the rise in C-sections. You could develop scar endometriosis even if you didn't have endometriosis before surgery.

This article discusses endometriosis after C-section and what you need to know about diagnosis and treatment.

Woman with endometriosis

Prostock-Studio / Getty Images

Could Pain After a C-Section Be Endometriosis?

Pain on your C-section scar can be a sign of endometriosis. However, endometriosis isn't the only reason for pain on or near the surgical scar. The pain can be chronic or cyclic (changing with your menstrual cycle). It's important to note that symptoms may not start for months or even years after your surgery.

Other Causes of Pain After C-Section

You can expect pain and discomfort after abdominal surgery, including a C-section, when you're recovering from surgery and pregnancy. In addition to bleeding and discharge lasting four to six weeks, other symptoms may include pain or numbness at the incision site.

It's also normal to have contractions as your uterus works to return to its prepregnancy size, which generally subsides within a few days to a few weeks.

Rare but serious complications that can cause pain include infections of the uterus or other pelvic organs, skin infection, injury to the bowel or bladder, and blood clots. Another cause of chronic pelvic pain after a C-section is isthmocele, or C-section scar defect, in which a pouch forms on the uterine wall from not healing completely.

After three months of follow-up, as many as 1 in 4 women report chronic postsurgical pain after C-section.

There's no cure for endometriosis, so there's always a chance of recurrence after treatment. Having endometriosis may put you at higher risk of pregnancy complications and the need for a C-section. C-section is a risk factor for scar endometriosis, but it's still considered a rare event.

Appearance and Location

Scar endometriosis is located on or near the C-section scar. You might be able to feel a mass or lump. Other signs and symptoms may include:

  • Swelling
  • Brownish discharge from a lesion near the scar when you have your period
  • Visible mass near the scar

You might also experience tenderness, lower abdominal discomfort, or pain. These sensations can be chronic or fluctuate according to your menstrual cycle.

The Difficulty of Diagnosis 

Interest in endometriosis after C-section has been circulating in online forums, perhaps due to the difficulty in getting a diagnosis. The diagnosis can be complicated by the fact that it's so uncommon.

Symptoms can be somewhat vague, and there may not be any visible signs. Sometimes, it can take up to 10 years from the first symptoms to diagnosis. Signs and symptoms can be similar to:

  • Lipoma (harmless growth under the skin)
  • Hernia (organs push through weak muscles, for example, a scar after surgery)
  • Abscess (a painful collection of pus under the surface of the skin)
  • Desmoid tumor (a benign connective tumor)
  • Malignancies (cancer)
  • Suture granulomas (benign growths that form as a reaction to materials used in the stitches)

Your healthcare provider may send you for testing to help with diagnosis. The tests may include:

Endometriosis vs. Adenomyosis

In endometriosis, tissue grows outside the uterus, including the fallopian tubes, ovaries, vagina, bowel, intestines, or a surgical scar. In adenomyosis, tissue grows inside the muscular wall of the uterus so that it won't involve a C-section scar. It can lead to an enlarged uterus and heavy periods. It's possible to develop both conditions at the same time.

Treatment for C-Section Scar Endometriosis 

Hormonal treatments may temporarily relieve symptoms but are not usually effective in treating scar endometriosis.

The primary treatment is the surgical removal of the mass and at least 1 centimeter of surrounding healthy tissue to help prevent a recurrence. Recurrence after this surgery is between 1.5% to 9.1%.

Managing Symptoms of Chronic Endometriosis 

Endometriosis treatment depends on factors such as your symptoms, age, and whether you would want to get pregnant. Symptoms aren't precisely the same for everyone, and it may take trial and error to find what works for you.

Your provider may recommend hormone therapy to stop the ovaries from producing hormones. This may slow growth and prevent new lesions from forming, but it also interferes with fertility. It's important to discuss all potential side effects with your provider to find the right fit for you. Options include:

You can also try pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin (ibuprofen) and Aleve (naproxen). These medicines are available over the counter, and your provider can prescribe stronger versions if necessary.

At-Home Remedies

You may be able to find relief with self-care remedies, such as:

  • Apply heat: Soak in a warm bath or rest a hot water bottle or heating pad on your abdomen to relax muscles and relieve pain.
  • Exercise: Physical activity helps blood flow and triggers endorphins, which can lessen pain.
  • Eat well: A balanced, healthy diet can promote overall health. If you strain during bowel movements, try adding more fiber to your diet.
  • Relieve pressure: When lying on your back, relieve pressure by placing a pillow under your knees. If you're a side sleeper, curl your knees toward your chest.
  • Relax: Being relaxed can help ease pain, so try techniques such as deep breathing, meditation, muscle relaxation, biofeedback, and yoga.

Summary

Endometriosis is a chronic condition with no cure. It happens when endometrial cells grow outside the uterus. C-section scar endometriosis is when endometrial cells grow in the scar left by your C-section. This can happen even if you didn't have endometriosis before pregnancy. Having endometriosis increases the risk of needing a C-section.

You may have chronic pain or pain that fluctuates with the menstrual cycle. The primary treatment is surgery to remove the mass, after which there's a low recurrence rate

A Word From Verywell 

You don't have to live with chronic pain. Talk to your healthcare provider about endometriosis if you ever had a C-section and have pain at or near the incision. An ob-gyn (obstetrician-gynecologist) who specializes in endometriosis can make the diagnosis and recommend treatment. You might also consider seeking an endometriosis support group to learn how others cope.

Frequently Asked Questions

  • What are the differences between endometriosis vs. endometritis?

    Endometriosis is when endometrial tissue grows outside the uterus. The cause is unclear. Endometritis is when the endometrium is inflamed or irritated due to infection. The two conditions have a lot in common in that they both involve chronic inflammation and symptoms such as abnormal bleeding and pain.

  • Why is C-section a risk factor for endometriosis?

    One theory is that endometrial cells become detached from the uterus during a C-section and are transferred to the surgical site. One small study found that obesity may also play a role. It can take two years or more after surgery for symptoms to occur. This can also happen after a hysterectomy and other types of abdominal surgery.

  • How do you find providers who understand C-section endometriosis?

    Endometriosis treatment usually involves an ob-gyn. Since C-section endometriosis is unusual, finding one with this specific experience might be challenging. You can ask your primary care provider for a referral to an endometriosis specialist. You can also ask for information on endometriosis support groups.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Ann Pietrangelo
Ann Pietrangelo is a freelance writer, health reporter, and author of two books about her personal health experiences.