My senior cat licks her urinary area raw, leaks urine. What's wrong?

Poor Sofie! I would make sure they have also ruled out any type of bladder stone. They can do this by take X-rays or with an ultrasound. Also, you may consider she could be suffering from sterile cystitis. This is basically inflammation of the bladder without bacteria. To help treat This you can try adding in consequin which is a joint supplement but it causes the mucus in the bladder wall to increase therefore decreasing inflammation. You can also talk to your vet about putting her on the specimen bladder food called science diet c/d stress. Urethral spasms isn’t very common in female cats but not impossible. You could talk to your vet about that as well and see if they would want to start her on prazosin. This medicine can affect their blood pressure so they may not want to start her on it without knowing for sure the problem or they may just want to monitor her blood pressure closely. Final option I can think of is an anti-anxiety medicine that can sometimes help sterile cystitis called amitryptilline. I hope this helps to guide you in your conversation with your vet to help Sofie feel better.