The river flows north, enters the Komi Republic, and downstream from the confluence with the Mutnaya turns east.

The mouth of the Tsilma is opposite to the selo of Ust-Tsilma, the administrative center of Ust-Tsilemsky District.

There is an unpaved road along the banks of the river downstream from the village of Filippovo.

The Tsilma is navigable at the 59 kilometres (37 mi) stretch of the lower course, downstream from the village of Trusovo.

The merchants were going upstream the Pukshenga, then moved to the Pokshenga and went downstream to the Pinega.