Background: A cesarean section (CS) is a life-saving surgical procedure when certain complications arise during pregnancy and labor. However, it is a major surgery and is associated with immediate maternal and perinatal risks and may have implications for future pregnancies as well as long-term effects that are still being investigated. This study aims at determining the prevalence of isthmocele (niche) among those who gave birth through Cesarean section, and figure out how many of the women diagnosed with scar niche are symptomatic. Methods: This observational cross-sectional study involved 300 women who gave birth by CS at the latest 6 months and they were recruited from the outpatient clinics of obstetrics and gynecology department, Tanta university hospital. Results: The prevalence of the niche was 21.7%. And the most common shapes of niche documented were the semicircular defects followed by the triangular defects. The majority of cases were symptomatic while only 7.7% were asymptomatic and discovered accidentally by routine ultrasound examination. The most common symptoms documented were abnormal uterine bleeding (AUB), chronic pelvic pain, dysmenorrhea, and secondary infertility. There was a positive significant relationship between the number of CS, the size of the niche, and the severity or frequency of the presenting symptom (P value < 0.01). Conclusion: Cesarean scar niche has a strong statistically significant association with symptoms such as AUB (especially inter-menstrual bleeding), chronic pelvic pain, and dysmenorrhea. In our study, the prevalence of cesarean niche was 21.7% and the common niche shapes documented were the semicircular and triangular niches.