You are right in that rectals are your best bet for proctosigmoiditis. You could try switching up on your 5ASA form... some people do better on different ones. Lialda worked wonders for me for quite a while when I first went on it.
It sounds like you are doing all the right things. Ultimately the decision to go on immunomodulators (like 6mp) is up to you, but if you are struggling to get/keep things under control at this level of meds, and you are starting college soon, then I would expect some trouble brewing in your future. You want to get things into remission before things get too stressful. You could try a round of prednisone to just kick-start the remission and then just stay on your current meds after that. That might work since yours is not too bad yet. If that doesn't work though (or if you already tried it), then I would recommend the stronger meds.
Here is the reason I say this: from the age of fifteen to my mid twenties, I had mild proctosigmoiditis, and after getting my first flare under control (with the exact combo you're on, actually), it was very manageable with just 5ASA's (both ends). Oral for maintenance, and enemas for flares. It got a bit bumpy when I was in an intense master's degree program and into my first year of teaching - so much stress - but settled back down after that and remained pretty manageable with just the Asacol and enemas. Then all of a sudden last year (due to an insanely stressful life-situation) it got really out of control, really quickly. TO be honest I had kind of ignored some previous symptoms, just using my usual meds because I was too busy to address the flare and thought it would just settle back down once I got on top of things, like it always had in the past. But by the end of the school year I was diagnosed with severe pancolitis - it had spread to my whole colon. That was over a year ago, and I have not been able to get into remission since then... the whole last year has been a horrible roller coaster of intense drugs, awful side-effects, symptoms, and constant worry that my colon has gone haywire. I am now making an appointment for surgery. (Click on my link below if you want to read all the details.)
I don't want to scare you, but I only share this with you to let you know that UC can be a sneaky little ******. Best to keep things as under control as possible and not let it get away from you. Good luck, and keep us posted!
Follow my story: ronnielee-fightingforit.blogspot.com
32-year-old single female (teacher)
Dx mild/moderate ulcerative colitis 1995
Dx severe ulcerative pancolitis 2011
Remicade (intolerant), Wellbutrin (100mgs x2), Asacol HD (4800mgs), Rowasa, probiotocs, L-glutamine, omegas, vitamin D, MMJ. No wheat, dairy, caffeine, alcohol, chocolate, processed foods... totally CLEAN diet.
Post Edited (bootstrap) : 8/12/2012 3:29:43 AM (GMT-6)