Pyuthan borders Dang Deukhuri District to the southwest along the crest of the Mahabharat Range and extends about 50 km (31 mi) northeast through the Middle Hills to a 3,000+ meter ridge that is both Pyuthan's border with Baglung district of Dhaulagiri Zone and the main watershed between the (west) Rapti and Gandaki River basins.

Its alluvial plain is intensively planted in rice during the summer monsoon.

Madi Khola has eroded an inner gorge and is less suited to traditional irrigated agriculture.

At the time of the 2011 Nepal census, Pyuthan District had a population of 228,102.

[5] Ethnicity/caste: 32.7% were Magar, 24.9% Chhetri, 14.0% Kami, 9.8% Hill Brahmin, 4.2% Sarki, 3.3% Sanyasi/Dasnami, 3.2% Damai/Dholi, 1.7% Newar, 1.5% Gurung, 1.5% Kumal, 1.1% Thakuri, 0.5% Gharti/Bhujel, 0.5% Tharu, 0.3% Musalman, 0.2% Badi, 0.1% Gaine, 0.1% Lhomi, 0.1% Tamang, 0.1% Thakali and 0.1% others.