Wastewater is one of the most significant issues that arise as a result of increased economic activity, urbanization, and population density. Depending on the source, wastewater may contain organic waste, pathogens, nutrients, pesticides, heavy metals, and other chemicals related to pharmaceuticals, personal care products, industrial, and household products. In recent years, wastewater from both point and non-point sources has increasingly begun to contaminate Bhutan’s surface water resources. Open disposal of untreated wastewater into the environment pollutes the environment, which then poses a threat to human and ecological health. This review article aimed to present the current state of wastewater generation and contamination of surface water resources in Bhutan. A review of secondary data sources, including published research, media reports, government legislations and regulations, and policy documents revealed that wastewater contaminants are increasingly polluting Bhutan’s surface water resources, necessitating immediate remediation. The Bhutan Environmental Standards (2020) does not contain discharge standards for all emerging contaminants that may cause chronic toxicity, endocrine disruption in humans and aquatic fauna, and disease outbreaks. Therefore, regular monitoring and controlling of contaminants discharged into the surface water bodies should be a national priority for Bhutan.