Radiation therapy plays a significant role in the integrated treatment for patients with pelvic malignancies, but may lead to radiation-induced rectal injury in some patients, which may affect their physical health and quality of life negatively. Patients with radiation-induced rectal injury are often complicated with pelvic multi-organ injury. Collaborative, multidisciplinary evaluation of pelvic injuries should be highlighted in clinical practices, including clinical, endoscopic, radiological and histopathologic evaluation. To determine the overall treatment strategy and develop individualized treatment strategy, it is necessary to assess the oncologic prognosis, severity and stage of radiation-induced rectal injury and clinical classification using different rating scales. Considering that the disease is self-limiting, non-surgical treatment should be performed for patients with early lesions, while surgical interventions should be performed as soon as possible for patients with severe complications. In terms of prevention of radiation-induced rectal injury, prevention should be targeted for patients at high risk of radiation-induced rectal injury through technique improvement, physical protection and drug prevention. This consensus aims to provide guidance for the clinical practice of radiation-induced rectal injury in China.