The Tutaekuri River originates deep in the Kaweka Ranges and flows southeast across Hawke's Bay before emptying into a shared estuary with the Ngaruroro River near the coast. Prior to the 1931 Hawke's Bay earthquake, the river discharged through the Ahuriri Estuary behind Napier Hill; the seismic event altered its course to its current outlet.

The most documented paddling section runs from the Lawrence Hut area (accessed via Donald Road) downstream to Dampney Road near Dartmoor. This reach is rated Grade 3 and passes through a rocky gorge. It is noted as not particularly well-known among paddlers, and flow data for trip planning purposes carries some uncertainty. The Dampney Road access involves a gravel road where two-wheel drive is not recommended when wet, and a ford on this route is only considered safe at normal river flows.

A flow monitoring station is located at Ngaroto on the lower river, and real-time flow data is available online through flowrate.co.nz, which paddlers use to assess runnability. The Hawke's Bay Regional Council provides public access to the lower river at Omaranui Road, Hakowhai. Motorized boats are not permitted on the Tutaekuri River.

The shared estuarine mouth where the Tutaekuri meets the Ngaruroro and Te Awa o Mokotūāraro rivers provides habitat for migratory birds and is noted as a birdwatching area. Camping is not permitted at Regional Council river access points due to flood risk, as river levels can rise quickly and unexpectedly.