The Ishëm proper is formed at the confluence of the rivers Gjole and Zezë, a few km northwest of Fushë-Krujë.

[7][8] The Ishëm is formed from several rivers which arise to the northeast of Tirana in the Skanderbeg Mountains beyond the Krujë range.

It flows in a westerly direction until it reaches the edge of the Tirana Plain, then turns to the northwest and heads for the Adriatic.

The quantities of ammonia, nitrogen dioxide, and suspended solids exceed EU legal limits on several different measures.

[1] At its mouth, the river smells very bad and the bay is polluted by the wastewater, plastic, and other detritus from Tirana, which threatens an important sea turtle breeding ground.