Cationic surfactants from the group of quaternary ammonium compounds (QACs) are widely used in disinfectants, cosmetics, and household and industrial products. Their strong antimicrobial activity and chemical stability make them valuable in applications but also highly persistent and toxic when released into aquatic environments. This problem has become increasingly relevant during and after the COVID-19 pandemic, when global use of QAC-based disinfectants increased drastically, resulting in their frequent detection in municipal, hospital, and industrial effluents. The concentrations of QACs reported in wastewater range from trace levels to several mg/L, often reaching inhibitory thresholds for biological treatment processes. Although surfactants are not listed in any current European directive, the revised Directive (EU) 2024/1440 classifies micropollutants as a priority group, imposing stricter environmental quality standards and mandatory monitoring requirements. Within this regulatory framework, QACs are recognized as compounds of emerging concern, and their effective removal from wastewater has become a critical challenge. This review summarizes the current knowledge on conventional treatment technologies (coagulation, adsorption, ion exchange, advanced oxidation, and biological processes) and membrane-based methods (ultrafiltration, nanofiltration, reverse osmosis, forward osmosis, and hybrid systems) for the removal of cationic surfactants from water and wastewater. Mechanisms of separation, performance, and operational limitations are discussed.