Widespread concerns raised in changes in the health risk of soil heavy metals exposure due to extreme rainstorm under climate change. However, the impacts of extreme rainstorm on human exposure risk and the underlying mechanisms are still unclear. In this study, soil properties, speciation distribution and bioaccessibility of Ni, Cu, Zn, Cd and Pb in soil samples, which were collected before and after extreme rainstorm, were measured, subsequently the soil oral exposure risk of heavy metals was assessed based on bioaccessibility. Results indicate that extreme rainstorm can significantly enhance the accumulated non-carcinogenic and carcinogenic exposure risk by 10.1–188.3 %, with lowland soil posing 1.3–1.7 times higher risk than highland soil. The increase in exposure risk varies among elements in highland and lowland soil. Specifically, the exposure risk for Cd and Pb increased by 2.5–9.7 times, whereas that for Cu decreased by 43.2 % - 60.6 %. The risk of Zn and Ni exposure exhibits complex trends, with an increase of 37.2 %–104.8 % in lowland soil but a decrease of 9.4 %–46.5 % in highland soil. Bioaccessibility variations are the primary risk factors for soil heavy metal exposure during extreme rainstorms, not total concentration. Mechanistically, the extreme rainstorm directly increases soil moisture content and reduce organic matter concentration, leading to an increment in the proportion of bio-utilization speciation and decrement in the speciation bounding to Fe/Mn oxides of soil heavy metals. Furthermore, the bioaccessibility of soil heavy metal positively correlates with their bio-utilization speciation and negatively correlates with their speciation bounding to Fe/Mn oxides, which ultimately increasing exposure risk. Our study suggests the necessity that attentions should be paid to the enhanced health risk associated with soil heavy metal exposure following extreme rainstorm, particularly for population residing in lowland areas.