From the Guidelines
Mucus in the urine, also known as pyuria, is most commonly caused by urinary tract infections (UTIs), which can be complicated by factors such as anatomical abnormalities or comorbidities, as noted in the 2024 European Association of Urology guidelines 1. The presence of mucus in the urine is not a normal finding and requires medical attention to determine the underlying cause. Possible causes include:
- Urinary tract infections (UTIs)
- Kidney stones
- Sexually transmitted infections
- Certain autoimmune disorders While waiting for a medical appointment, it is recommended to increase fluid intake to help flush out the urinary system and avoid self-medicating with antibiotics or other treatments without professional guidance. A healthcare provider may order:
- Urinalysis to assess white and red blood cells and nitrite
- Urine culture and antimicrobial susceptibility testing to identify bacterial infections
- Imaging studies like ultrasound or CT scans to check for kidney stones or structural abnormalities in the urinary tract Treatment will depend on the underlying cause, but may include:
- Antibiotics for bacterial infections
- Anti-inflammatory medications for certain conditions
- Specific treatments for identified disorders As noted in the 2024 guidelines, fluoroquinolones and cephalosporins are recommended for oral empiric treatment of uncomplicated pyelonephritis 1. Understanding the cause of pyuria is crucial for appropriate treatment and preventing potential complications, such as urosepsis, which can occur if obstructive pyelonephritis is not promptly diagnosed and treated 1.
From the Research
Causes of Mucus in Urine (Pyuria)
- Infection is a common cause of pyuria, especially cystitis, urethritis, sexually transmitted infections, and vaginitis 2
- Noninfectious inflammatory causes include a foreign body in the urinary tract and dermatologic conditions 2
- Noninflammatory causes of pyuria include medication use, urethral anatomic abnormalities, local trauma, and interstitial cystitis/bladder pain syndrome 2
- Cystinuria, a genetic disorder, can also lead to kidney stone formation and potentially cause pyuria 3
- Recurrent lower urinary tract infections (UTIs) can be caused by bacterial, candidiasis, or papillomavirus infections, which can be diagnosed through cytological examination of urine 4
- Urine tests, such as urine sediment microscopy, automated urinalysis, and routine urine dry chemical methods, can help diagnose UTIs and identify the cause of pyuria 5
- Urine sediment examination can provide valuable information about underlying kidney disease and guide therapy 6
Diagnostic Approaches
- A targeted history and physical examination can help identify the cause of pyuria 2
- Urinalysis and urine culture can confirm the diagnosis of a UTI and identify the causative pathogen 2, 5
- Cytological examination of urine can help differentiate between bacterial, candidiasis, and papillomavirus infections 4
- Urine sediment examination can provide additional diagnostic information and guide therapy 6