Investigating the influence of human activities and climate change on streamflow and sediment load is of great significance for understanding the hydrological cycle, addressing climate change, and ensuring sustainable water resource management. Based on observed data of precipitation, streamflow, and sediment load from 1990 to 2021 in the Xiliugou Basin, trend and abrupt change analyses of streamflow and sediment load were conducted using the coefficient of variation and Bayesian change point detection method. The effects of climate change and human activities on streamflow and sediment load were further examined through the double mass curve method, with a focus on the impact of land use changes on streamflow and sediment load dynamics. The results indicated that: (1) During the study period, there was a consistent decreasing trend in streamflow, sediment load, and precipitation, with respective rates of −77.76 × 104 m3/year, −55.97 × 104 Mt/year, and −0.84 mm/year. The distribution of annual streamflow and sediment load in the basin was uneven, with 61.05% of precipitation occurring during the wet season and the peak sediment discharge month being July, accounting for 58.90% of the total annual sediment load. (2) The variations in streamflow and sediment load in the Xiliugou Basin exhibited distinct stage characteristics, with abrupt changes occurring around 1997. Both streamflow and sediment load showed significant fluctuations from the reference period to the changing period, decreasing by 45.54% and 82.85%, respectively. (3) A positive correlation between precipitation and streamflow was observed in the Xiliugou Basin, with correlation coefficients (R) of 0.62 and 0.49, indicating a stimulating effect of precipitation on streamflow and sediment load. Human activities significantly reduced sediment load in the Xiliugou Basin from 1998 to 2021, contributing to a reduction of 115.08%. (4) An increase in cropland, water, and barren areas would lead to higher streamflow and sediment load, while an increase in grassland, forest, and impervious areas would decrease both streamflow and sediment load.