Background <p>Pelvic organ prolapse (POP) is a common condition affecting elderly women. This study aimed to evaluate whether combining pelvic floor muscle training (PFMT) with electromagnetic stimulation (EMS) provides better outcomes than PFMT alone, using objective three-dimensional (3D) ultrasound parameters.</p> Methods <p>We conducted a retrospective analysis of 240 elderly women with POP treated between January 2023 and January 2025. Based on the received treatment, patients were grouped to a PFMT group (<i>n</i> = 114) or a PFMT–EMS group (<i>n</i> = 126). All patients underwent a standardized 15&#xa0;week intervention. We assessed pelvic floor 3D ultrasound parameters, Pelvic Organ Prolapse Quantification (POP-Q) stage, pelvic floor muscle strength metrics, and symptom scores pre- and post-treatment.</p> Results <p>This analysis included 240 patients. The PFMT–EMS group showed significantly greater improvement in key ultrasound parameters, including a smaller levator ani hiatus area on Valsalva (<i>P</i> &lt; 0.001) and reduced bladder neck descent (<i>P</i> &lt; 0.001). This group also achieved better POP-Q stage improvement (<i>P</i> = 0.013), greater enhancement in muscle strength and symptom relief (all <i>P</i> &lt; 0.001), and a higher total effective rate (<i>P</i> = 0.027).</p> Conclusion <p>Combining PFMT with EMS produces superior anatomical and functional outcomes in elderly women with POP than PFMT alone.</p>