Rectal smooth muscle tumors less than 5 cm in diameter and pathologically benign can be resected endoscopically, while those that are too large or pathologically malignant require radical resection. Rectal smooth muscle tumor mainly occurs in the lower part of the rectum, and can develop from vascular smooth muscle, erector spinae muscle or smooth muscle of the intestinal wall, which is relatively rare. Rectal smooth muscle tumors are usually associated with blood in the stool, change in stool shape, pus and blood in the stool, generalized fatigue, anemia, etc. Therefore, timely treatment is needed when the diagnosis has been confirmed. Surgery is the first choice for rectal smooth muscle tumor. When the diameter is less than 5cm and the pathology suggests benign, endoscopic resection is possible. If the diameter is too large, endoscopic resection is not possible, need to be incised and resected, and has been malignant need to carry out radical resection, non-metastatic can be a whole piece of excision of the tumor and the surrounding tissues until the edge of the incision is normal under the microscope, has been metastasized can only be treated by radiotherapy. Regular follow-up is needed after surgery to prevent recurrence of the disease.