Why Mariánské Lázně is among the most comprehensive spas in Europe
Mariánské Lázně (Marienbad) is one of the few places in the world where more than 40 mineral springs of differing chemical composition rise within a relatively small area. Thanks to this variety, it is a spa resort listed in the Czech indication list for nine groups of diseases — from the musculoskeletal system through the kidneys to the airways. In 2021 the town was inscribed on the UNESCO World Heritage List as part of the Great Spa Towns of Europe, confirming its exceptional role in the history of European spa culture.
Spa treatment in Marienbad rests on three pillars: mineral springs of unique composition, natural peat from the Slavkov Forest and natural carbon dioxide from the Maria Spring. Since 2023, the status of a climatic spa has been added — clean air and an altitude of 630 metres allow climate therapy to be included in the treatment plan as well.
This guide summarises which diagnoses are treated here, how the individual treatments work and what research says about them. It does not replace medical advice: whether spa treatment is suitable for you, and which treatments you receive, is decided by your treating doctor and then by the spa physician at the initial examination.
The main therapeutic indications
The musculoskeletal system
Disorders of the locomotive system (indication group VII) are the most common reason for visiting Marienbad: osteoarthritis of the hips and knees, chronic back pain, inflammatory rheumatic diseases in their quiescent phase and conditions after orthopaedic surgery. Treatment combines peat wraps, CO₂ mineral baths, physiotherapy and exercise in the pool.
This is the best-researched area of balneology. According to a systematic review, spa treatment for knee osteoarthritis eases pain and improves function, clinically meaningfully for 3 to 6 months and sometimes up to 9 (Forestier et al., 2016, Ann Phys Rehabil Med); a randomised trial with 145 patients confirmed that the difference from usual care persists 6 months after a three-week cure (Forestier et al., 2025, Int J Biometeorol). For chronic low back pain, a French randomised trial with 102 patients recorded less pain and lower medication use still at 9 months after a three-week cure (Guillemin et al., 1994, Br J Rheumatol). Spa treatment does not restore cartilage; its aim is to ease pain and stiffness and improve mobility for months at a time.
A separate item on the list is rehabilitation after surgery of the hip and knee joints or the spine (VII/10–11, basic stay 28 days in comprehensive care). Patients usually arrive six to eight weeks after the operation; the programme combines exercise in the pool, individual physiotherapy and gentle warm treatments under daily supervision. More in the article Musculoskeletal treatment.
Kidneys and urinary tract
Mariánské Lázně is a spa resort listed in the indication list for diseases of the urinary tract (group VIII): kidney stones, chronic inflammations of the kidneys and urinary tract, conditions after surgery and after stone fragmentation, chronic prostatitis and conditions after kidney transplantation. The basis of treatment is a drinking cure from the bicarbonate springs — the Rudolph and Caroline Springs.
According to the guidelines of the European Association of Urology, the basis of preventing recurrent stones is adequate fluid intake and metabolic evaluation with targeted treatment according to the stone type (Skolarikos et al., 2024, Eur Urol). A drinking cure is a way of acquiring such a regime under medical supervision. Bicarbonate waters also measurably change the composition of urine: in 34 patients with recurrent stones they raised urinary pH, citrate and magnesium (Karagülle et al., 2007, World J Urol), and in a randomised trial with 51 patients they increased urine volume, magnesium, pH and citrate over 12 weeks compared with plain water (Lu et al., 2022, Int Urol Nephrol). Alkalising the urine is not, however, appropriate for every type of stone, which is why the choice of spring is decided by the physician after analysis of the stone and the urine. More in the article Kidney and urinary tract treatment.
Airways
Non-tuberculous diseases of the respiratory system (group V) — chronic bronchitis, asthma, conditions after lung surgery and others — are among the indications of Mariánské Lázně. Treatment combines inhalations of mineral water, respiratory rehabilitation and climate therapy in the Slavkov Forest. A systematic review of 27 studies describes better nasal patency, mucociliary clearance and some lung parameters after inhalations of thermal waters, with the caveat that the studies are of low quality (Fontana et al., 2025, Int J Biometeorol). Treatment of asthma or COPD is led by the pulmonologist; the spa complements it.
Digestive tract and metabolism
Digestive system illnesses (group III) and metabolic disorders including diabetes and obesity (group IV) are further indications. The Cross Spring — the most strongly mineralised spring in Marienbad, with a high sulphate content — is traditionally prescribed for diseases of the gallbladder, liver and digestive tract. In a controlled study with 40 women, 12 days of drinking sulphate-bicarbonate water improved gallbladder emptying and stool frequency (Corradini et al., 2012, World J Gastroenterol); for functional constipation, a magnesium sulphate water in a double-blind trial with 226 patients achieved a response after 14 days in 50% compared with 29% — the trial was manufacturer-funded and the water had a different composition from that of Marienbad (Dupont et al., 2019, Nutrition). The Forest Spring, mildly mineralised, is often chosen by physicians to top up fluid intake. More in the article Spa treatment for digestive disorders.
Oncological rehabilitation
Oncology cases after completion of treatment with no signs of relapse (item I/1) are among the indications. The aim of the programme is to restore physical fitness, ease fatigue and return to everyday activities. In a French randomised trial with 181 women in remission from breast cancer, a spa programme increased the return to work and family activities at 12 months (Mourgues et al., 2014, Eur J Oncol Nurs), and a meta-analysis of five trials showed that aquatic exercise after breast cancer reduces fatigue and improves quality of life (Wang et al., 2022, PLoS ONE). Whether a stay is suitable is decided by the oncologist. More in the article Post-oncology spa programme.
Other indications
Mariánské Lázně is also a listed spa resort for illnesses of the circulatory system (group II), nervous system diseases (group VI) and skin diseases (group X). A full overview of the items, with type of care and length of stay, can be found in the indication list.
Natural healing resources
The six main mineral springs
The Cross Spring is the most strongly mineralised spring, with a high content of dissolved salts. It is traditionally prescribed for diseases of the digestive tract — the gallbladder, liver and pancreas. It stands in an elegant pavilion in the middle of the spa park.
The Rudolph Spring is prescribed for diseases of the kidneys and urinary tract. Its water, with a higher content of calcium and bicarbonates, is traditionally the basic spring for patients with urinary stones and inflammations. It is among the most visited springs in the town.
The Caroline Spring stands out for its elevated magnesium content. Physicians often prescribe it to urology patients in combination with the Rudolph Spring at a different time of day. The drinking pavilion is close to Ensana Centrální Lázně.
The Forest Spring is the best-known and most popular spring in Marienbad. It rises directly in the Ensana Centrální Lázně building. Its mild mineralisation makes it a suitable spring for beginners in the drinking cure and for topping up the daily fluid intake.
The Ferdinand Spring is the oldest documented spring in Marienbad, mentioned in monastery records as early as 1528. It is traditionally used for diseases of the digestive tract and is popular for its gentle taste.
The Ambrose Spring is used for inhalation therapy in chronic diseases of the airways. The inhalatorium is located in the Maria Spa complex.
Peat from the Slavkov Forest
The peat is extracted in the protected area of the Slavkov Forest near the town. It contains humic acids, fulvic acids and mineral salts and has low thermal conductivity, so it releases heat slowly and evenly. A wrap heated to 42–45 °C is applied for 20 minutes; the warming dilates the blood vessels, eases muscle tension and reduces the sensitivity of painful nerve endings. Peat wraps are part of musculoskeletal treatment, whose effect in osteoarthritis and back pain is documented by the studies cited above.
Natural CO₂ from the Maria Spring
The Maria Spring is a source of natural carbon dioxide at a purity of 99.7%. The gas is used for gas injections and dry CO₂ baths — traditional Marienbad treatments. CO₂ penetrating the skin dilates the cutaneous vessels and increases blood flow in the skin and subcutaneous tissue; this mechanism is summarised in review papers on CO₂ balneotherapy (Pagourelias et al., 2011, Int J Biometeorol).
Climate therapy — since 2023
Mariánské Lázně was granted the status of a climatic spa in 2023. The town lies at an altitude of 630 metres, surrounded by the woods of the Slavkov Forest, with clean air free of industrial pollution. Climate therapy includes guided walks in nature (terrain therapy), breathing exercises in the fresh air and gradual hardening according to the spa physician's plan.
How the drinking cure works
The drinking cure is the foundation of spa treatment in Marienbad, and you can look at the overview of mineral springs on a separate page. The principle is simple: the patient drinks a prescribed quantity of mineral water from specific springs, at precisely set intervals and temperatures.
A typical daily regime looks like this: the morning drinking cure begins 30–60 minutes before breakfast. The patient slowly sips 200–300 ml of water from the prescribed spring during a walk in the spa park. The drinking is repeated before lunch and sometimes before dinner. The total daily dose is around 1–2 litres, always under the supervision of the spa physician.
Water from the Marienbad springs has a temperature of 7–10 °C and a pronounced mineral taste. The traditional vessel is the spa cup — a porcelain cup with a spout that allows slow sipping. You can buy one in any souvenir shop in town.
Important: Never start a drinking cure on your own initiative. Each spring has a different composition and suits different indications. A wrongly chosen spring can make your condition worse. Always follow the spa physician's recommendation.
Gas injections and CO₂ baths
Gas injections consist of the subcutaneous application of natural CO₂ from the Maria Spring. The gas is applied with a fine needle under the skin in the area of the affected joints or section of the spine; the treatment takes a few minutes, and the injection site may be briefly tender or tight. It is a traditional Marienbad treatment that the spa physician adds as a complement to peat wraps, baths and physiotherapy; a standard course comprises 10–12 applications every other day.
Dry CO₂ baths are another form of CO₂ treatment. The patient is immersed in a gas bath (without water), where CO₂ penetrates the skin into the body. The treatment takes approximately 20 minutes and is pleasant — the patient feels a mild tingling and warmth. The unique Maria's Dry Gas Pool at Maria Spa offers this treatment in a modern form. Both treatments have contraindications; whether they are included is decided by the physician.
The initial medical examination
Every therapeutic stay in Marienbad begins with an initial examination by the spa physician. The examination usually takes place on the day of arrival or the following morning and lasts approximately 30–45 minutes.
The physician studies your medical records (it is advisable to bring them), carries out a basic examination and, on the basis of the diagnosis, draws up an individual treatment plan. This covers the specific treatments and their frequency, the prescription of a drinking cure from selected springs and any dietary recommendations. Only the spa physician decides which treatments you receive and which are not suitable for you.
During the stay there are regular check-ups — the physician adjusts the plan according to your response to treatment. A final examination before departure assesses the results and provides recommendations for care at home.
How long does a stay last
The length of a therapeutic stay is set by the indication list and the proposal of the treating doctor, not by a general rule. For comprehensive spa care covered by insurance it is 21 or 28 days depending on the item on the list, for contributory care 14 or 21 days; for example, knee osteoarthritis (VII/7) has a basic stay of 21 days, conditions after joint replacement (VII/10) 28 days and kidney stones (VIII/2) 21 days. The exact lengths for each diagnosis can be found in the indication list; for guests insured in the Czech Republic, the procedure with the insurer is described in the guide to the spa treatment voucher.
Self-paying guests most often choose one to three weeks in consultation with the spa physician. The specialist literature regards two to three weeks with 10–21 treatments as the usual length of spa treatment; a stay shorter than ten days with fewer than ten treatments is regenerative rather than therapeutic in character (Maraver et al., 2020, Int J Biometeorol). How long the effect lasts is documented only for some diagnoses — for knee osteoarthritis and chronic back pain 3 to 6 months, sometimes up to 9 (see the studies above).
Where treatment takes place
The complex of interconnected Ensana hotels — Ensana Nové Lázně, Ensana Centrální Lázně, Ensana Hvězda and Maria Spa — offers direct access to the treatment facilities. Patients staying in any of these hotels can reach their treatments through internal corridors without having to go outside. Ensana Centrální Lázně has historic treatment halls from the 19th century with original tiling — among the most beautiful in Europe. Ensana Nové Lázně is famous for the Roman Baths of 1896, which still serve their original purpose today.
The treatment team includes spa physicians, physiotherapists, balneologists and nutrition advisers. Communication is in Czech, German and English — and with some physicians in Russian as well.
Practical information
Mariánské Lázně lies in western Bohemia, approximately 160 km from Prague (2 hours by car). The town is also easy to reach by train — the direct connection from Prague takes approximately 3 hours. From Plzeň it is just under an hour. Details on transport can be found in the practical information section.
To answer the most common questions about spa treatment, we have prepared a detailed frequently asked questions page, where you will find information on insurance, length of stay, meals and other practical matters.
For up-to-date information on treatment programmes and spa care, visit the official website of Léčebné lázně.
