Cam-lobe radial-piston hydraulic motors are widely used as rotation driving units for various marine machinery owing to their ultrahigh output torque (more than 100 kN m). A multi-row cam roller bearing (MCRB) is the key component that directly determines the fatigue life of a cam-lobe radial-piston hydraulic motor. However, compact geometry and complex loads render MCRB susceptible to fatigue failure, highlighting the need for an optimized MCRB to achieve longer fatigue life and higher reliability. Therefore, this study proposes an innovative geometry optimization method for an MCRB to improve its fatigue life. In this method, a quasi-static model was developed to calculate the load distribution, with the fatigue life of the MCRB calculated using both basic dynamic loading and load distribution. Subsequently, a genetic algorithm was used to obtain the optimized geometry parameters, which significantly improved the fatigue life of the MCRB. Finally, a loading test was conducted on a hydraulic motor installed with both the initial and optimized MCRB to validate the effectiveness of the proposed optimization method. This study provides a theoretical guideline for optimizing the design of MCRB, thereby increasing the fatigue life of hydraulic motors.