The proposed Padma Barrage aims to restore freshwater flow to southwestern Bangladesh, but it may also alter sediment transport, distributary connectivity, and river dynamics across the Southern Bengal Delta. Drawing on historical river records, historical maps, published evidence, and the geomorphological evolution of the Padma–Brahmaputra–Meghna system, this Perspective conceptually hypothesizes how altered flow and sediment regimes could affect distributary connectivity, channel migration, erosion, sedimentation, salinity distribution, and the long-term stability of the region. It further argues that the proposed USD 4.1 billion investment warrants assessment beyond its anticipated short-term freshwater benefits, with greater attention to long-term hydrological, geomorphological, ecological, and climate-related consequences. It further calls for consideration of diversified alternatives, including decentralized freshwater storage, large-scale rainwater harvesting, managed aquifer recharge, climate-resilient irrigation, distributary restoration, and basin-scale water management.