VLADIMIR Putin has long prided himself on his "strongman" image – but a dramatic change in his appearance over the past few years has prompted speculation that he may be suffering from a severe illness.

His public appearances during the invasion of Ukraine have shown him out of breath, stumbling over his words, or looking exhausted, amid fears his days as a working president may be numbered.

This week, his alleged health issues hit a new low after it emerged that he apparently soiled himself during a rough and tumble fall at his official residence.

The Russian tyrant was allegedly helped to a sofa by bodyguards as his personal doctors rushed to assist him.

According to sources, the fall led to bruising of his coccyx, but also highlighted problems that experts believe have been on public show for months.

Political analyst Valery Solovey has gone on record to claim that Putin is suffering from a number of serious illnesses -including cancer, Parkinson’s disease and a schizoaffective disorder.

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Solovey believes his health "is deteriorating… dramatically" – and suggested the tyrant's medical conditions have impacted his judgment on the shambolic war. 

Recent pictures show Putin looking frailer with a puffy face, while critics say he has been gripping the side of desks during public appearances to hide his tremors.

During talks with his defence minister Sergey Shoigu, the elderly despot was filmed gripping the table and slouching in a sign he's suffering from Parkinson's.

And the Russian leader's hands trembled violently in a video clip showing him greeting Belarusian President Alexander Lukashenko at the Kremlin.

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Other footage showed Putin biting his lips and fidgeting distractedly at a church service, further stoking claims the autocrat has a terminal illness.

He also appeared to limp and grimace as he walked during talks in Moscow with UN Secretary-General Antonio Guterres in April.

A month later his head appeared "bloated" according to some commenters during a virtual meeting of Russia's security council.

While in June, Putin was given "urgent medical assistance" after being struck down by a "sharp sickness", according to Kremlin insiders.

Vlad was said to have fallen ill while talking to his military chiefs and suffered "sharp sickness, weakness and dizziness" as he got up from his desk after a 90-minute virtual session.

And in October, Putin appeared to be visibly in pain during a parade in Moscow's Red Square to celebrate breaking international law to annex four regions of Ukraine.

The ailing autocrat had a manic look with inflamed cheeks and a red face.

The sequence of events is said to have led the Kremlin to internally admit that Putin's health is "sharply deteriorating" – with suggestions he’s even used body doubles at some events in order to keep face with the public.

Bombshell spy documents later leaked to The Sun Online suggested that the Russian leader had been diagnosed with several illnesses.

"I can confirm he has been diagnosed with early stage Parkinson's disease, but it's already progressing," the Russian security services insider claimed in an email.

"This fact will be denied in every possible way and hidden.

"Putin is regularly stuffed with all kinds of heavy steroids and innovative painkilling injections to stop the spread of pancreatic cancer he was recently diagnosed with.

"It not only causes a lot of pain, Putin has a state of puffiness of the face and other side effects – including memory lapses.

"In his close circle, there are rumours that in addition to pancreatic cancer, which is gradually spreading, Putin also has prostate cancer."

In the past few months, Putin has been pictured with suspected track marks from IV treatment on the back of his hand – amid rumours he may have been suffering from other forms of cancer as well.

While troubling footage showed the Russian leader clutching his chair with a claw-like grip while his feet constantly twitched during a talk in September.

The sight was quickly repeated just days ago during a meeting with Kazakhstan president Kassym-Jomart Tokayev.

He has also displayed purple hands.

Parkinson's disease can cause dystonia, which is muscle twisting, spasm or cramp.

According to Parkinson's UK, it can appear during any stage of Parkinson’s.

Its website says those with the condition can suffer from "involuntary movements, spasms or twisting and 'curling'" in the arms, hands, legs and feet.

Unsurprisingly, Kremlin officials have always denied there is anything wrong with their leader and have allegedly made rushed attempts to conceal it at any given opportunity.

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In June, Putin's foreign minister Sergei Lavrov addressed the Putin health rumours for the first time, declaring on state TV channel TF1: "I don't think anyone with a good head can see any signs of disease or ailment in this person."

Kremlin press secretary Dmitry Peskov has also previously insisted that the president's health is "excellent".

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