Natural environments depend on rivers and fluvial ecosystems for freshwater, habitat, and biodiversity. Human dependence on these river systems has risen over the ages, causing severe human consequences. Human activities have many effects on river health, but this chapter focuses on Indian rivers principal stresses. The main anthropogenic stresses include changes in land use, urbanization, pollution, and hydrological factors. Urbanization, deforestation, and industrialization have caused watershed degradation and river pollution. Industrial effluents, agricultural runoff, and municipal garbage impair water quality, while microplastics and pharmaceuticals worsen it. Dams, barrages, and sand mining alter river flow, further deteriorating the ecosystems. Rising temperatures, hydrological extremes, and changed monsoonal patterns aggravate these demands, threatening water supply and ecosystem health. These human influences cause biodiversity loss, habitat fragmentation, and a decrease in the number of aquatic species. River fragmentation, eutrophication, and dead zones provide socioeconomic issues for populations relying on river resources like fisheries. This chapter also addresses these issues with possible remedies and mitigating techniques. Restoring river ecosystems requires strengthening the National River Conservation Plan, the Water (Prevention and Control of Pollution) Act, wastewater treatment technology, and community-driven initiatives. Collective responsibility and sustainable management may reduce anthropogenic influences and preserve these vital water resources.