I had ulcerative proctitis, limited to the rectum only for twelve LONG years. I did enjoy a few years of remission here and there (1998-2000 and then again after my bout in 2000, from mid 2000 - 2002). After that, I flared yearly and after my second hospitalization in 08, almost constant flare. 6MP kept me in remission from 2000 to 2002. I went the entire gamut, rectal meds, 6MP (seven years on that), Remicade (developed antibodies after 3rd infusion) and Humira (three months and no change). The rectal meds just dripped right out when I flared. I became prednisone dependent the last two years and decided to have the surgery...total colectomy and permanent ileostomy on June 28th. Best decision (other than marrying my wonderful husband ) that I ever made.
My advice is to try the meds but if they fail, seek out a good surgeon. I did NOT have a j-pouch. I am 64 yrs old and a long history with prednisone, my surgeon flat out refused me a j-pouch. When I told him I had no problem wearing a bag, he was ecstatic because he knew I had a badly diseased rectum. My colon only had minor diverticulosis but they won't just take out the rectum. It was a long recovery, had some blips, but I can finally say I feel GREAT! I went from taking 17 - 25 pills daily plus the rectal meds to taking 1 pill a day....Toprol for my BP and sometimes I wonder if I really even need that!
Best of luck to you. I hope you feel better. The rectum is very stubborn to treat.