<p>Several treatments have been used for benign colorectal anastomotic stricture (BCAS). We aimed to compare the safety and effectiveness of small and large balloon dilation for BCAS. Between October 2012 and February 2025, 43 consecutive patients with BCAS who underwent dilation of small balloon (SB Group, <i>n</i> = 29) and large balloon (LB Group, <i>n</i> = 14) were retrospectively evaluated. Patients’ characteristics, technical success, complications, and recurrence were analyzed. Technical success rates of dilation were 83.3% and 82.6% in SB Group and LB Group, respectively. After dilation, stricture diameter and stricture rates decreased significant in two groups (<i>P</i> &lt; 0.05). Stricture recurrence and colorectal perforation were the main reasons for technical failures. There were two colorectal perforations during dilation procedures in each group (<i>P</i> = 0.5784). Only one patient underwent surgical colon resection and colostomy immediately after perforation, and the remaining 3 patients healed spontaneously after conservative treatment. A total of 17 patients (32.6%) were clinically cured: 10 in the SB Group and 7 in the LB Group, respectively. The clinical effective rate was significantly higher in LB Group (92.9%) than that of SB group (65.5%, <i>P</i> = 0.0373). The duration of treatment in group LB was significantly shorter than that in SB Group (<i>P</i> = 0.0352). In conclusion, both small and large balloon are safe and effective for the treatment of BCAS. Large balloon dilation can be more preferable to small balloon because of its less treatment duration, similar complication incidence and better clinical effect.</p>