A pump-turbine may generate high-amplitude hydraulic excitations during operation, wherein the flow-induced response of the spiral case and concrete is a key factor affecting the stable and safe operation of the unit. The preloading spiral case can enhance the combined bearing capacity of the entire structure, yet there is still limited research on the impact of the preloading pressure on the hydrodynamic response. In this study, the pressure fluctuation characteristics and dynamic behaviors of preloading a steel spiral case and concrete under different preloading pressures at rated operating conditions are analyzed based on fluid–structure interaction theory and contact model. The results show that the dominant frequency of pressure fluctuations in the spiral case is 15 fn, which is influenced by the rotor–stator interaction with a runner rotation of short and long blades. Under preloading pressures of 0.5, 0.7, and 1 times the maximum static head, higher preloading pressures reduce the contact regions, leading to uneven deformation and stress distributions with a near-positive linear correlation. The maximum deformation of the PSSC can reach 2.6 mm, and the stress is within the allowable range. The preloading pressure has little effect on the dominant frequency of the dynamic behaviors in the spiral case (15 fn), but both the maximum and amplitudes of deformation and stress increase with higher preloading pressure. The high-amplitude regions of deformation and stress along the axial direction are located near the nose vane, with maximum values of 0.003 mm and 0.082 MPa, respectively. The contact of concrete is at risk of stress concentrations and cracking under high preloading pressure. The results can provide references for optimizing the structural design and the selection of preloading pressure, which improves operation reliability.