Most European riverine ecosystems suffer from the negative influence of impoundments on flow regime. Downstream effects of dams lead to a number of environmental and socioeconomic risks and, therefore, should be thoroughly examined in specific contexts. Our study aims to quantify the downstream effects of the Siemianówka Reservoir (Upper Narew, Poland), using statistical analysis of key elements of the river's flow regime, such as the flow duration and recurrence of floods and droughts. In a comparative study on control catchments not influenced by impoundments (the Supraśl and Narewka Rivers), we revealed the following downstream effects of the analyzed dam: significant shortening of spring floods, reduction of the duration and depth of summer droughts, decrease of the maximum discharge, and homogenization of the discharge hydrographs. Although we determined a significant decrease in the duration of summer floods in the "before" and "after" dam function periods, we showed that this issue is regional, climate-related, and replicated in control catchments, rather than an evident downstream effect of the dam. We conclude that significant hydrological downstream effects of the Siemianówka dam-reservoir system could have been the main driver inducing the deterioration of the anastomosing stretch of the Narew River downstream of the dam.