The functions performed by sanitary sewers can be disrupted by blockages in the pipeline, especially in cities with aging systems and deteriorating pipes. The problem is acute in Australia, where the principal blockage cause is tree root intrusion. This paper presents an overview of the causes of sewer blockages, the scope of the asset management challenge, and the management practices employed by Australian water utilities. These views were developed through reviews of the literature and current management practices elicited in a collaborative research project involving a range of water sector partners and using qualitative techniques such as surveys, interviews, and workshops. This paper highlights that blockages occur because of a range of factors, of which root blockages are the most common in Australia. Issues that confound management of blockages are also described, along with a summary of management strategies. Optimizing the balance between proactive and reactive interventions was found to be a good management strategy to maximize service outcomes.