Although the effects of sedimentation in caves have been recognised for many years, its role in speleogenesis is frequently overlooked. Influxes of sediment into a cave system fundamentally alter the way cave passages develop, either by alluviation in a vadose environment, forcing lateral corrosion and the development of notches, or by upwards dissolution in a phreatic environment through a process known as paragenesis. Sediment influxes affect the hydrological functioning of a karst aquifer by changing the way conduits behave and subsequently develop both in plan and long section. Here we give an overview of the mechanisms of cave sedimentation and describe how the process of alluviation and paragenesis affect speleogenesis. A characteristic suite of meso- and micro-scale dissolutional features can be used to recognise paragenetic development, which is reviewed here. In a vadose environment these include alluvial notches, whilst in a phreatic environment, half tubes, anastomoses and pendants, bedrock fins and paragenetic dissolution ramps result. Using these to identify phases of sedimentation and paragenesis is crucial for reconstructing denudation chronologies from cave deposits. We suggest that sedimentation and paragenesis are most likely to occur in certain geomorphological situations, such as ice marginal and periglacial environments, beneath thick residual soils and where rivers can transport fluvial sediment into a cave, either via stream sinks or back-flooding.