The bridge was constructed in 1160 during the time of Bishop Hugh de Puiset a powerful Prince Bishop, who instigated a significant amount of building work in northern England.

The bridge has a total of ten arches. There is however, some dispute over how many arches exist. Sixteenth century antiquarian John Leland believed the bridge had 14 arches, but this has never been proved. The river flows through four full arches - the remainder are dry or semi-dry. Ten arches have been identified, others may be hidden beneath the street on the Elvet side or beneath Souter Peth. A key reason for the construction of the bridge was the urban development taking place in what was the then Elvet borough.

The bridge was repaired extensively under Bishop Fox between 1495-1501, and again in 1601. In 1771 a flood badly damaged it.

In the mediaeval period Elvet Bridge was guarded by a gate and towers, and a number of buildings were situated upon it. This included two chapels which stood at either end (one of which was later replaced with a House of Correction (Prison). The chapel upon the eastern, Elvet, side of the bridge has survived partially intact to the present day and is particularly visible when viewed from the riverbanks to the south.

There are two other ancient bridges in Durham, Framwellgate and Prebends, both on the west side of the peninsular.