Lower gastrointestinal bleeding and rectal prolapse in children have a broad differential diagnosis influenced by age, nutritional status, comorbidities, and geographical exposure. In endemic regions, intestinal schistosomiasis should be considered among infectious causes of chronic gastrointestinal blood loss and inflammatory colorectal disease. Rectal prolapse secondary to schistosomiasis is rare, and operative intervention is infrequently required. A 5-year-old girl presented with a six-month history of intermittent rectal bleeding and full-thickness rectal prolapse, accompanied by progressive weakness and abdominal distension. Severe microcytic hypochromic anaemia was identified, with a haemoglobin level of 2.7 g/dL. After blood transfusion and clinical stabilisation, open abdominal sacral rectopexy was performed because of persistent, ulcerated prolapse with ongoing bleeding and failure of conservative management. Intraoperative findings included thickening of the sigmoid colon, whitish serosal patches, enlarged mesenteric lymph nodes, and hepatomegaly. Stool ova testing was requested but unavailable. Histopathological examination of biopsied tissue revealed active Schistosoma eggs within granulomas, confirming the diagnosis. This case illustrates an advanced presentation of intestinal schistosomiasis in a young child, complicated by life-threatening anaemia and full-thickness rectal prolapse requiring surgical correction. In endemic settings, children with chronic rectal bleeding, anaemia, abdominal symptoms, or prolapse should undergo targeted evaluation for schistosomiasis. When stool microscopy is unavailable or inconclusive, histopathology can provide definitive confirmation. Earlier recognition, guided by exposure history, appropriate ova testing, and haemoglobin assessment, may reduce the risk of progression to severe complications.