Objective To investigate the efficacy and safety of natural ori-fice specimen extraction surgery （NOSES） for internal hemorrhoids with rectal mucosal prolapse. Methods A total of 100 patients with internal hemorrhoids and rectal mucosal prolapse admitted to our hospital from January 2022 to January 2024 were selected and divided into a control group and a study group by random number table method, with 50 patients in each group. The control group underwent traditional laparoscopic surgery, while the observation group underwent NOSES. Surgical related indicators [operation time, intraoperative blood loss, postoperative visual analogue scale （VAS） score, and postoperative hospital stay], preoperative and postoperative Wexner constipation scores, and postoperative complications （hematochezia, fever, and urinary retention） were compared between the two groups. Result There was no significant difference in intraoperative bleeding between the two groups （P>0.05）. The study group had significantly longer operation time, lower postoperative pain （VAS） scores, and shorter hospital stay than the control group （P<0.05）. Compared with before surgery, both groups showed a significant decrease in Wexner constipation scores 8 weeks after surgery （P<0.05）, while there was no significant difference between the two groups 8 weeks after surgery （P>0.05）. There was no significant difference in the incidence of postoperative complications between the two groups （P>0.05）, and there was no recurrence in either group during the 6-month follow-up after surgery. Conclusion NOSES for internal hemorrhoids with rectal mucosal prolapse has significant advantages in reducing postoperative pain and shortening hospital stay, with no recurrence rate, providing a safe and effective new treatment option for clinical practice.