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Waterfalls along the river include Rainbow Falls and the Boiling Pots (a series of small falls and pools). The upper and middle reaches of the river are known for hunting of introduced game animals. The lower river is a popular destination for swimming and tubing. Wailuku River State Park is located along the lower reach of the river.
The lower reach of the river is used for the generation of hydroelectricity. The flow at Hilo averages 1 million cubic meters (275 million gallons) daily, increasing by a factor of 20 during heavy storms. The stream carries an average of 10 tons of suspended sediment into Hilo Bay each day.