Introduction and Hypothesis <p>This study evaluates the prevalence of pelvic organ prolapse (POP) symptoms among women in Fushun and compares transperineal ultrasound (TPUS) and pelvic floor muscle (PFM) strength parameters across different symptom groups.</p> Methods <p>A cross-sectional study recruited 237 participants aged ≥ 18&#xa0;years. Data collection included the self-reported simple pelvic floor impact questionnaire (SPFIQ), three-dimensional TPUS, and PFM strength measurements. Among them, 196 participants underwent physician interviews and were divided into two groups based on International Continence Society (ICS) diagnostic criteria to compare TPUS and PFM parameters.</p> Results <p>Higher body mass index (BMI) and alcohol consumption were associated with stress incontinence. Urinary retention correlated with self-reported conditions and higher dynamic vaginal pressure (DVP). A higher bladder neck position at rest (BNPR) reduced POP risk, while increased bladder neck mobility (BNM) elevated the risk of stress incontinence and POP. Levator hiatus area during Valsalva (LHA-Valsalva) was positively correlated with POP symptoms. Postmenopausal women showed more colorectal–anal symptoms, linked to type II pelvic floor muscle fatigue (PFMF-II). Clustering analysis identified two groups: one with mild symptoms and minimal quality-of-life impact, and another with significant urinary incontinence (UI) affecting daily activities, characterized by increased BNM and reduced PFM strength. In the physician-interviewed subset, bladder neck position during Valsalva (BNPV), BNM, and LHA-Valsalva showed varying predictive values for urinary incontinence.</p> Conclusions <p>POP symptoms are significantly associated with higher BMI, alcohol consumption, self-reported conditions, postmenopause, and specific PFM and TPUS parameters. TPUS measurements, including BNPV, BNM, and LHA-Valsalva, offer predictive insights for clinical assessment and management of POP.</p>