Symptoms and diagnoses should have been distinguished

EDITOR,—I was disappointed to see Chris Dawson and Hugh Whitfield perpetuating the error of using the terms stress incontinence and urge incontinence as if they are diagnoses when they are in fact symptoms.1 It must be over 25 years ago that it was realised that the symptom stress incontinence is not pathognomonic of the condition of genuine stress incontinence and the symptom urge incontinence is not pathognomonic of an unstable bladder. While it is true that most patients with the symptom stress incontinence have genuine stress incontinence and most of those with the symptom urge incontinence have an unstable bladder, several authors, including myself, have shown that about a quarter of women with an unstable bladder complain of the symptom stress incontinence even though they do not have genuine stress incontinence and over 35% of patients with genuine stress incontinence and a stable bladder complain of the symptom urge incontinence.2

The need to distinguish between symptoms and signs and the accepted terminology have been defined by the International Continence Society in its classification of lower urinary tract dysfunction, published in the British Journal of Urology in 1976 and in the British Journal of Obstetrics and Gynaecology in 1990.3 4

Distinguishing between the symptoms and the diagnosis is not pedantry. If the diagnosis is confused with symptoms then between 25% and 37% of patients will be offered the wrong treatment.