The advent in satellite altimetry with the most accurate satellite radar altimeter since 1992 and its successive missions have enabled the routine global monitoring of water-level (or stage) for surface waters and changes in the quantities of dammed water reservoirs. However, satellite altimeter measurements typically have spatial resolution capable of observing only large water bodies, such as major lakes and rivers. This paper addresses the challenges of how to investigate water levels in medium (~ 1 km in width) to small (~ 100 m and narrower) rivers. Comparisons between the ENVISAT altimetry ICE-1 waveform retracking height and standard water-level measurements for multiple sections of Ohio River, Columbia River, and Red River of the North in the United States (US) reveals that the satellite altimetry measured water levels agree well with those observed at nearby US Geological Survey gaging stations over the 10-year period starting from 2002. The significant results include those obtained at Thompson, North Dakota (ND, correlation coefficient or R value of 0.76 between satellite and in situ water-level measurements) and Fargo, ND (R = 0.74), where the stream channels of Red River are merely ~ 50 m and ~ 40 m wide, respectively, under normal climatic conditions. In addition, demonstrations of the approach over largely inaccessible portions of Tigris–Euphrates Rivers and Helmand River in the Middle East aided in understanding hydrology in these systems. This study demonstrates the ability of satellite radar altimetry to characterize rivers in these study regions which are much narrower than 100 m in width.