The spiral case plays a role in providing stable and uniform water flow in the pump-turbine unit, and the overall structure with the surrounding concrete is an important foundation for the safe and stable operation of the unit and power plant. In order to clarify the comprehensive bearing capacity of preloading steel spiral case under pump operating conditions, this study is based on the theory of the fluid–structure coupling and contact model and uses ANSYS CFX 2021 R1 and mechanical to analyze the flow fluctuation characteristics and dynamic structural response of a preloading steel spiral case and surrounding concrete under different preloading pressures in the intermediate head pump condition. The results indicate that the main frequency of pressure fluctuations inside the main frequency (1 fn) of pressure fluctuations inside the spiral case is influenced by the unstable flow. The contact state between the preloading steel spiral case and concrete is closely related to the relative magnitude of preloading pressure and hydraulic pressure. Higher preloading pressure can lead to an increase in initial preloading clearance, resulting in a decrease in contact area. The vortex motion inside the spiral case is the main factor affecting the distribution of deformation. The rotor–stator interaction also has a certain impact on the vibration of the spiral case structure, even though the influence of rotor–stator interaction on pressure fluctuation inside the spiral case is already small. The monitoring points where the maximum values of static stress and dynamic stress are located are different. Increasing the preloading pressure value does not always guarantee the safety of concrete structures, as the sticking contact area in early contact transfers most of the stress of the spiral case, resulting in significant stress concentration. Under the working conditions of this study, the concrete in contact with the inner edge and nose vane is subjected to excessive loads. Therefore, it is necessary to reinforce the structure with steel bars or other methods to improve its tensile strength. A minimum preloading pressure value of 3.2 MPa is beneficial for reducing the risk of concrete cracking. The research results can provide a deeper understanding of the behavior of preloading steel spiral cases under pump conditions and guide optimization design.