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An elderly woman — something coming down; uterine prolapse; pessary fitted. Genital prolapse (uterine descent — multiparity, menopause — cystocele — anterior, rectocele — posterior, uterine: degrees — procidentia — complete: treat — pessary — elderly unfit; surgery — vaginal hysterectomy + repair; Manchester — fertility): urinary incontinence (stress — cough/sneeze leak — sphincter weakness — Kegels first; sling — TVT; urge — detrusor overactivity — urgency — bladder training + anticholinergics — solifenacin; mixed — treat both; fistula — continuous leak — repair). The cough leak is stress — Kegels first.