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Fecaloma is a rare complication of chronic constipation with fecal impaction, which usually is underestimated. The megacolon would be noted as a result of that the harden stool commonly obstructs the rectum and sigmoid colon. So far, numerous cases about obstructive uropathy caused by fecaloma have been reported. We present the case of a 63-year-old female with a history of hemorrhagic stroke, who experienced acute bilateral hydronephrosis and fecaloma. She was successfully treated by colonoscopy irrigation and manual manipulation. In this literature, we focus on the association with the change of bowel movement after brain injury and remind neurosurgeons the clinical care about bowel program. [ABSTRACT FROM AUTHOR]