<p>Coastal regions worldwide face increasing threats from continuous sewage discharges. This review synthesizes current approaches for monitoring, mapping, and modelling of sewage contamination in coastal environments, including laboratory-based methods, in situ techniques, and remote sensing technologies. Existing studies mostly rely on biological tracers and nutrient indicators to detect sewage contamination. However, research remains limited in developing countries, where sewage discharges are more prevalent and poorly managed. The review also evaluates global legislative frameworks and management strategies, emphasizing their effectiveness, limitations, and adaptability. Emerging studies report the far-reaching impacts of sewage pollution on coastal ecosystems and human health. These impacts are now evident across global coastlines, regardless of the development status of the country and the effectiveness of local management. Key knowledge gaps persist, especially the lack of integrated monitoring frameworks and actionable management solutions. This review addresses these challenges and supports interdisciplinary research, coherent policy alignment, and active stakeholder involvement to control sewage pollution in the coastal environment.</p>