The river originates at the edge of the Shan Hills southeast of Mandalay, and flows southward to the Gulf of Martaban.

Although it flows through fairly flat country, the Sittaung has a notorious tidal bore at its mouth which has precluded any but very small craft navigating the river.

The Sittaung empties into the Gulf of Martaban where the tide-dominated coast is a Ramsar wetland of international importance.

[3] Strong currents make the river even less valuable as a means of transport in eastern Burma.

Its basin does not have the same richness for agriculture as the Irrawaddy because there is no soil flowing down from the Shan Hills.