In reptiles, the prolapse of tissue from the cloaca is always considered as an emergency and requires immediate treatment. Three compartments are distinguished in the cloaca of reptiles, the coprodeum, the urodeum, and the proctodeum. First, the prolapsed organ must be clearly identified. Gender-related and species-specific differences (e.g., reptile species with or without urinary bladder) must be taken into account. In principle, the cloacal mucosa, the distal gastrointestinal tract, the urinary bladder (if present in this species), parts of the reproductive tract, such as salpinx or clitoris in females, and penis or one or both hemipenes in males, may prolapse. In general, a cloacal prolapse is always based on an underlying disease. This should always be addressed to, in addition to the immediate treatment. To clarify etiology, radiographs are taken in two, in turtles in three, planes to diagnose urinary bladder stones, fecal retention, foreign bodies in the gastrointestinal tract, etc. Blood test and parasitological fecal examination are also recommended. If underlying causes, such as e.g. metabolic bone disease, severe parasite infestation, foreign bodies, coprostasis, egg retention or urinary bladder stone(s) are not diagnosed and treated right, the short-term medical care of the prolapse has no chance of lasting success. Practical hints for the definitive identification of the prolapsed organ, necessary diagnostic techniques, emergency procedures to be initiated immediately, the resulting different treatment options such as tissue preservation, as well as the possible need for partial or complete amputation of the organ, will be discussed in detail.