Coastal backwater effects on low-gradient coastal plain rivers extend well upstream of the head of the estuary and propagate upstream as sea-level rises. Hydrological, geomorphological, and ecological indicators can serve as sentinels of the upriver encroachment. Analyzing the along-river spatial distribution of these indicators as a space-for-time substitution allows the prediction of sequential changes. Interpretation of results from 20 rivers in Virginia and the Carolinas shows that backwater effects at the leading edge result in higher river stages, increasing floodplain inundation, and raising water tables. Lower slopes and flow velocities reduce sediment transport, reducing river sediment input and floodplain deposition. This inhibits natural levee development, reducing bank heights. These factors combine to increase the frequency and duration of inundation, resulting in semi-permanently flooded wetlands. Anaerobic conditions limit organic decomposition, and ponding allows transported and suspended organic matter to settle, leading to organic muck and peat floodplain soils. This accumulation, coupled with general valley-filling, buries alluvial terrace remnants. Finally, vegetation changes driven by salinity increases occur, resulting in swamp conversions to brackish marsh. Backwater encroachment is strongly controlled by channel bed slope, with relatively steeper channels experiencing slower rates of tidal extension. With accelerating sea-level rise (SLR), the lowest-sloping channels could experience encroachment rates of >1 km yr−1. Hydrological changes associated with SLR are most rapid at the leading, upriver end—averaging 71 km upstream of the head of the estuary in the study rivers at present—and at the lowermost, downstream end of the fluvial-estuarine transition zone.