The Rivière Macaza originates at Lac Cinq-Doigts in the Rouge-Matawin Wildlife Reserve, high in the Laurentians, and flows approximately 27 km south before joining the Rouge River near the village of La Macaza. Along its course, the river widens three times to form Lac Sucreries, Lac Sapin, and Lac Macaza, giving the route a varied character that alternates between open lake paddling and moving water.

Between the lakes, paddlers encounter class II-III rapids with occasional class IV sections, making the river best suited to kayakers with intermediate to advanced whitewater skills. The mix of rapid grades means that trip planning should account for scouting and portaging options, particularly around the class IV drops.

The upper reaches between Lac Cinq-Doigts and Lac Sucreries are undeveloped, offering the most remote paddling experience on the river. This section and the lakes themselves are noted as the best areas for camping. The Rouge-Matawin Wildlife Reserve, through which the upper river runs, provides a broader network of camping options: the Lac-des-Sucreries campground near the main reserve entrance at La Macaza offers 40 semi-serviced sites, and seven additional rustic camping areas are distributed throughout the reserve, each situated on a lake or river.

Near the confluence of the Rivière Macaza and the Rouge River at La Macaza stands a covered bridge dating to 1904, the only remaining covered bridge in the Rouge valley. It is a notable landmark at or near the takeout point for a full river run.

The Rouge-Matawin Wildlife Reserve context suggests the surrounding landscape is characterized by rugged mountain and lake terrain typical of the Laurentians north of Parc National du Mont-Tremblant. The river's relatively short length and defined lake-to-lake structure make it well suited to multi-day trips, with the upper section offering the most wilderness character and the lower reaches providing access to semi-serviced facilities.