topicals not working

Have you tried steroid rectal meds, or just the mesalamine?

If you are at the max dosage of mezavant (aka lialda) and 6mp, then you need to try steroids (either in oral or rectal form) to get your flareup under control. Prednisone is an oral pill that is 100% systematic, meaning you are going to get side effects elsewhere in your body but it is good at what it does. The enema-based steroids are 90% topical, so you are less likely to get side effects than with prednisone and work just as wel. There is also a delayed-release coating on Uceris, an oral pill-based steroid that is 90% topical, so it is preferable to prednisone. The only down-side is Uceris is brand-named, new, and can be pricey. The steroid enemas should be available in generics.

I notice nothing helps me either. Rectals used to help me when I was dealing with mild proctitis... I use them regardless. It may be the case that things are inflamed beyond the area the rectals can reach. it's still good to treat the rectum so it doesn't get worse.