The female pelvic floor is composed of muscles, fascia, and ligaments responsible for closing the lower pelvis and support the pelvic organs, in addition, to perform the urethral, vaginal and anal closure. Abnormalities in its physiology are associated with deficits in urinary, sexual and defecation functions. 
 Pelvic floor disorders (PFD) such as urinary incontinence, anal incontinence, and pelvic organ prolapse (POP) appear to affect a large number of women and can be associated with aging, causing significant morbidity. Consequently, the costs related to health care, decreased productivity and quality of life are significant (1).
Prevalence studies about PFD have emphasized mainly urinary and anal incontinence. Other authors also addressed the different clinical situations of PFD, but elderly women often represent a small sample of the studied population (2). Thus, based-population studies that evaluate PFD in elderly women using an objective and standardized physical assessment method are relevant.
The aim of this study was to estimate the prevalence of PFD in elderly women in the municipality of Petrolina, Brazilian northeast.

A cross-sectional study was performed between December 2016 and April 2018. The sample size was calculated involving the population of 16.905 elderly women (60 years or older), attended by primary health care. Based on the 95% confidence level and 5% margin of error, the sample size was calculated in 376 elderly women. The selection process was determined by means of multistage sampling, which involved a sequence of stages of random draws from the Primary Care Health Units (PCHU). Petrolina has 343.865 inhabitants and 84.74% of the population is registered in 40 PCHU, including rural and urban areas.
The first stage consisted of a random selection of 20 PCHU. In the second stage, a community health agent (CHA) from each PCHU chosen in the first stage was randomly selected. In the third stage, each CHA was responsible for visiting 15 elderly women. When the sample size for that basic unit exceeded 15 elderly women, another CHA was randomly selected. In case of refusal or exclusion, a new drawing was carried out.
Women aged 60 years or older, able to perform the Valsalva maneuver and that signed the informed consent were included. Data collection consisted of two stages. First, two instruments were filled out: a sociodemographic and clinical questionnaire, and The FIGO assessment scoring system (FASS) related to urinary and bowel symptoms as well as related to bulge symptoms. In the second stage, the physical examination was performed according to the FASS classification.
The analysis was performed using a descriptive and inferential statistical approach. In the descriptive approach, the distribution of absolute and relative frequencies was made for categorical variables. The study was authorized by the Municipal Health Department and approved by the Institutional Ethics Committee (Protocol 1.478.255 and CAAE 51039415.0.0000.5207). The collected data were analyzed using SPSS version 22.0.

A total of 399 women were studied, aged 60 to 93 years old (68.64 ± 6.65). There was a higher prevalence of women in the sixth decade of life, illiterate or with incomplete elementary education, mulatto, presenting overweight or obesity. Also, more than half of the women were multiparous (more than 5 births).
A high percentage (70.2%) of the patients studied had at least one symptom related to PFD, with 37.6% being only one of the types of symptoms (urinary, bowel or bulge symptoms), 24.1% reported two of them, and 9 (3%) had all three types surveyed. More than a half of the patients had urinary symptoms, being urinary incontinence the most frequent. Symptoms related to storage as urgency, frequency, and nocturia were also prevalent. Bowel symptoms were reported by one third of the women, being incomplete emptying or digitation the most prevalent symptoms. Although more than 77.5% of the sample had significant POP, only 22% of them reported symptoms related to prolapse (Table 1).

The present study is one of the few population-based studies which evaluated PFD by active search in the community, determining the prevalence of related symptoms and the presence of POP through physical examination. Large prevalence studies usually use bulge symptoms as only POP evaluations. Self-report can underestimate the true prevalence of POP, as demonstrated in the present study. Other authors assessed urinary incontinence, POP, and anal incontinence symptoms and also evidenced the high prevalence of PFD in elderly women (3). Urinary incontinence, storage urinary symptoms, and bowel emptying difficulties are the most prevalent PFD.

The prevalence of PFD in elderly women is high. Adequate public policies for this population must include PFD as relevant to establish better well-being.

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Lilian Ghandour,Vatche Minassian, Ahmed Al-Badr, Rami Abou Ghaida, Sandra Geagea, Tony Bazi. Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study. Int Urogynecol J (2017) 28:105–118.
Berihun M. Zeleke, Robin J. Bell, Baki Billah, Susan R. Davis. Symptomatic pelvic floor disorders in community-dwelling older Australian women. Maturitas 85 (2016) 34–41.