Defects in cesarean scar results from a postoperative complication of the uterine isthmus, also known as an isthmocele. This is a reservoir-like pouch defect on the anterior wall of the uterine isthmus located at the site of a previous cesarean scar. The flow of menstrual blood through the cervix may be slowed by the presence of isthmocele, as the blood may accumulate in the niche and, together with the presence of fibrotic tissue, cause pelvic pain. The removal of the local inflamed tissue improves symptoms and restores fertility. We report the case of a 39-year-old with history of inter-menstrual bleeding, pelvic pain and dysmenorrhea. Images studies revealed a cesarean scar defect connected to a small cavity in the myometrium compatible with an isthmocele. After surgical excision, symptoms resolved. This case highlights the importance surrounding diagnosis, management and benefits of surgical repair of uterine scar defect after cesarean section.