The district lies within three physiographic regions namely the southern voltaian Plateau consisting of a series of escarpments, notable among which is the Kwahu scarp rising from 220m to 640m above sea level. This scarp has two prominent mountains – namely the Odwenanoma and Apaku.
The second physiographic region is the Forest Dissected Plateau which consists of steep-sided Birimian rocks rising to heights up to 240m.
Thirdly, the plains which stretches into the southern Voltaian Plateau and rises from 60m to 150m above sea level.
Among the major rivers that drain the district are the Afram and Pra rivers. The river Afram is a major tributary of the Volta and flows through the northern border of the district with the Afram Plains. The Pra River take its source from the Kwahu scarp in the District. The Pra river take its source from Kwahu Twenedruase and flows through Akwasiho and Kwahu Praso where it leaves the district. The Volta Lake is an important resource which provide employment to many fishermen and fish mongers who have settled along the lake. Communities such as Adawso, Nketepa, Kotoso, Sempoa and Dadeso Wireko are well noted for their fishing activities. It could be a major source of irrigation for the production of vegetables all year round.
Waterfalls found in the district include the Oworobong, Oku Abena and Buku located at Oworobong, Bokuruwa and Kwahu Tafo respectively. These have the potential of being developed into tourist sites for both domestic and foreign purposes. A number of springs are found in the district eg Asuo Yaa at Obomeng. Though majority of these springs are seasonal in character, further investigation into them could result in their exploitation for the production of mineral water.
The topography consists of the Southern Voltaian Plateau, the forest-dissected plateau and the Voltaian basin. The Southern Voltaian Plateau, otherwise known as the Kwahu Scarp, rises to heights of about 220m to 640m above sea level. The forest dissected plateau also rises to height of about 240m, while the Voltaian basin is Afram, a tributary of the Volta and Pra, which takes its source from the district.