Objective To investigate the efficacy and safety of total colpocleisis in treatment of elderly women with pelvic organ prolapse (POP). Methods A total of 78 elderly women with POP quantification (POP-Q) stage of Ⅲ－Ⅳ undergoing total colpocleisis in gynecologic department of Foshan Maternal and Child Health Hospital from January 2012 to January 2018 were recruited in this study. All patients were followed up for 1 year, and preoperative and postoperative POP-Q stages, pelvic symptoms and satisfaction were recorded and analyzed. Preoperative and postoperative quality of life were evaluated using the pelvic floor distress inventory short form-20 (PFDI-20) [including urinary distress inventory-6 (UDI-6), colorectal-anal distress inventory-8 (CRADI-8), pelvic organ prolapse distress inventory-6 (POPDI-6)] and pelvic floor impact questionnaire-7 (PFIQ-7). Chi-square test was used to compare the preoperative and postoperative POP symptoms, and student′s t test was applied to compare the life quality between preoperation and post-operation. Results The overall efficacy was 98.71% (≤stage Ⅰ), and 1 case experienced recurrence (≥stage Ⅱ). POP symptoms, such as vulvar mass prolapse, pelvic distension, frequent urination and urgent to urinate, dysuria, stress urinary incontinence, and defecation difficulty were significantly reduced postoperation (P<0.05). The subjective satisfaction was 100%. The points of PFDI-20 (UDI-6, CRADI-8, POPDI-6) and PFIQ-7 preoperatively were significantly lower than those preoperatively, with statistical differences (P<0.05). Conclusion Total colpocleisis can significantly decrease the POP-Q stage and pelvic symptoms, and obtain postoperative satisfaction and quality of life in elderly POP patients.