The river rises on the slopes of Mount Teshio in the Kitami Mountains. After flowing through Takinoue, the river is joined by the Sakurū and Tatsuushi Rivers. At Kamishokotsu in Monbetsu, the river leaves the mountains for the coastal plain. There it is joined by the Utsutsu River before flowing into the Sea of Okhotsk at Shokotsu in Monbetsu.