The effects of land and water management practices (LWMP)—such as the construction of dams and roads—on river flows typically have been studied at the scale of single river watersheds or for a single type of LWMP. For the most part, assessments of the relative effects of multiple LWMP within many river watersheds across regional and national scales have been lacking. This study assesses flow alteration—quantified as deviation of several flow metrics from natural conditions—at 4196 gauged rivers affected by a variety of LWMP across the conterminous United States. The most widespread causes of flow changes among the LWMP considered were road density and dams. Agricultural development and wastewater discharges also were associated with flow changes in some regions. Dams generally reduced most attributes of flow, whereas road density, agriculture and wastewater discharges tended to be associated with increased flows compared to their natural condition.