Presacral hemorrhage after pelvic surgery usually results in massive, life-threatening bleeding. It is often difficult to control this presacral hemorrhage with standard hemostasis techniques after rectal mobilization. Mobilization of the rectum is part of the daily maneuvers of most pelvic surgeons. This review shows a common cause of presacral hemorrhage and demonstrates that the Bakri tamponade balloon catheter can control massive pelvic bleeding. A comprehensive, detailed review of the pelvic anatomy and hemostasis techniques used to control presacral hemorrhage was conducted. Also, a case study illustrated the novel use of the Bakri balloon for effective hemorrhage control. The presacral venous plexus or basivertebral sacral veins may be the sources of significant hemorrhage during rectal mobilization. The Bakri balloon effectively targets them. The standard recommendation for safe posterior dissection of the rectum to prevent presacral hemorrhage is approaching the plane between the mesorectal fascia and presacral fascia. We found that the Bakri balloon tamponade effectively controlled presacral hemorrhage and offers advantages over conventional packing. Massive hemorrhage is a potential complication of pelvic surgical procedures. Surgeons should be aware of hemostasis techniques for managing acute pelvic bleeding. We believe that the Bakri balloon should be included as a treatment option.