In this paper, a piezoelectric sensor-embedded smart rock is proposed for the electromechanical impedance monitoring of internal concrete damage in a prestressed anchorage zone. Firstly, a piezoelectric sensor-embedded smart rock is analyzed for impedance monitoring in concrete structures. An impedance measurement model is analyzed for the PZT (lead zirconate titanate)-embedded smart rock under compression in a concrete member. Secondly, a prototype of the smart rock embedded with a PZT sensor is designed in order to ascertain, sensitively, the variations of the impedance signatures induced by concrete damage in an anchorage zone. Thirdly, the performance of the smart rock is estimated from a numerical analysis and experimental tests. Variations in the impedance signals under compressive test cases are analyzed in order to predetermine the sensitive frequency band for the impedance monitoring. Lastly, an experiment on an anchorage zone embedded with the smart rocks and surface-mounted PZT sensors is conducted for the impedance measurement under a series of loading cases. The impedance variations are quantified in order to comparatively evaluate the feasibility of the sensor-embedded smart rock for the detection of internal concrete damage in the anchorage zone. The results show that the internal concrete damage was successfully detected using the PZT-embedded smart rock, thus enabling the application of the technique for anchorage zone health monitoring.