It runs through Fukushima Prefecture and Miyagi Prefecture, rising from springs in the peaks of the Nasu mountains, collecting water from tributaries leaving the Ōu Mountains and the Abukuma Highlands, then emptying into the Pacific Ocean as a major river.

Its watershed has a 5,400 km2 (2,100 sq mi) area, and about 1.36 million people live in its basin.

[2] The Abukuma River flows north through Fukushima Prefecture's Nakadōri region, past the cities of Shirakawa, Sukagawa, Kōriyama, Nihonmatsu, Date, and Fukushima.

The portion of the river flowing between Nihonmatsu and Fukushima forms a deep ravine called Hōrai-kyō (蓬莱峡).

[3] Crossing the northern edge of the long but low Abukuma hills, the Abukuma River then flows into Miyagi Prefecture, past the city of Kakuda and between Iwanuma and Watari before reaching the Pacific.