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The Inner Mongolia section of the Yellow River is a primary alluvial segment of the main channel. The variations in water and sediment not only alter the cross-sectional morphology and flow capacity of the river but also impact the scheduling of upstream cascade reservoirs. Based on runoff and sediment load data and topographic information from typical hydrological stations, the characteristics of runoff and sediment load variations and the evolutionary pattern of siltation in the Inner Mongolia River section were analyzed via trend analysis methods, Mann–Kendall test methods, the sediment load transport rate method, and the water level–flow relationship. The results showed that the water and sediment loads at the hydrological stations in the Inner Mongolia River section significantly changed from the 1960s to after 2000, with runoff decreasing by approximately 22% to 32% and the sediment load decreasing by approximately 65% to 73%. Sedimentation in the river section generally increased, and the average annual siltation amount reached 0.144 billion t. The joint utilization of the Longyangxia and Liujiaxia reservoirs in 1987 was the main reason for the rapid increase in siltation, and siltation in the Inner Mongolia River section was slightly reduced after 2005. In addition, the critical sediment load coefficients of the Bayangaole–Sanhuhekou and Sanhuhekou–Toudaoguai River sections were 0.0073 and 0.0051 kg·s/m6, respectively, from 1952 to 1968, and 0.0053 and 0.0037 kg·s/m6, respectively, from 1969 to 2020. This study could provide technical support for river flood control and reservoir water sediment regulation in Inner Mongolia. [ABSTRACT FROM AUTHOR]