The pollution of water bodies by pharmaceuticals and personal care products (PPCPs) has attracted widespread concern due to their widespread use and pseudo-persistence, but their effects on sediments are less known. In this study, solid-phase extraction-high performance liquid chromatography–tandem mass spectrometry (SPE-LC/MSMS) was used to investigate the occurrence and ecological risks of five typical pharmaceuticals and personal care products (PPCPs) in thirteen key reservoirs, sluices, dams, and estuaries in the Haihe River Basin. At the same time, the PPCP exchanges of surface water, groundwater, and sediments in three typical sections were studied. Finally, the PPCP’s environmental risk is evaluated through the environmental risk quotient. The results showed that the five PPCPs were tri-methoprazine (TMP), sinolamine (SMX), ibuprofen (IBU), triclosan (TCS), and caffeine (CAF). The average concentration of these PPCPs ranged from 0 to 481.19 μg/kg, with relatively high concentrations of TCS and CAF. The relationship between PPCPs in the surface sediments was analyzed to reveal correlations between SMX and TMP, CAF and IBU, CAF and TCS. The risk quotients (RQ) method was used to evaluate the ecological risk of the five detected PPCPs. The major contributors of potential environmental risks were IBU, TCS and CAF, among which all the potential environmental risks at the TCS samples were high risk. This study supplemented the research on the ecological risk of PPCPs in sediments of important reaches of the North Canal to reveal the importance of PPCP control in the North Canal and provided a scientific basis for pollution control and risk prevention of PPCPs.