The Karuah River is located in New South Wales, less than an hour north of Newcastle, flowing through Karuah National Park before emptying into the western end of Port Stephens. The river is over one hundred kilometres long, and the lower reaches are navigable for approximately eleven kilometres north of the Karuah bridge as far as the township of Allworth.

A popular paddling route runs between Allworth and Booral, described as a peaceful out-and-back trip. Allworth itself was once a significant river port from which steamships transported timber and farm produce to Sydney; it is now a quiet village. The Karuah town boat ramp at Memorial Park provides another access point near the river's lower end. The Double Wharf picnic area within Karuah National Park serves as a day-trip destination offering picnicking, bushwalking, fishing, and paddling in one location. The national park also contains two campgrounds — Little Mountain campground being one — making multi-day paddling trips feasible with at least two days of water to explore.

The lower river near the town of Karuah features active oyster farming operations on both sides of the waterway, and the waterfront in that area has an industrial character. Further upstream, the river passes through Karuah National Park, where the character shifts to a more natural setting. Wildlife observed along the river includes jellyfish, brahminy kites, and white-bellied sea eagles, along with land-based fauna such as bandicoots, goannas, and brush-tailed possums in the surrounding park.

The BIG4 Karuah Jetty holiday park operates a 250-metre private jetty on the river, where day visitors can moor during the day. Frozen bait and fishing rod hire are available at that facility. The Karuah National Park office can be reached at 02 4984 8200 for current park information, and the park may close at times due to poor weather or fire danger, which is worth confirming before planning a trip.