Stubborn rectal symptoms.

Hello all.
So I'm currently on Humira and Rowasa, and just now finishing a pred taper that I've been up and down on for well over 4 months or so. During the interim I've had a repeat colonoscopy showing inflammation limited to the last bit of distal colon and my rectum.
My GI is currently deciding whether or not to change me from Humira to Entyvio.
Currently, my symptoms are fairly manageable with the help of the enemas.. that is, I can retain them, sleep, and when

I wake up I'm pretty good--my BM's are solid and basically 'normal' without bleeding... until the end of my work-day, around 14 hours of being awake.

What happens at that point, is that I start getting gas that is impossible to pass without being on a toilet because mucus with small amounts of blood is blocking the way and has to come out with it. This continues non-stop until I once again put in the enema and sleep.

Now, I've only been on the Rowasa for about 3 weeks at this point (up until switching I was using steroid enemas)... really not sure where to go from here, or what to even ask for.. starting to get really depressed about this. It seems like I'm so close to a full remission but this last bit of symptoms just won't go away. Any ideas on which direction to take conversation with my next follow-up appointment?

Sounds frustrating, as you're having solids and generally doing well.

You said distal (left-side) inflammation was seen in your last endoscopy. Was that inflammation assessed to be mild, moderate, or severe?

What's your current Humira frequency (i.e., weekly, every-other-week)? Sometimes weekly helps.

Have you had a humira/adalimumab concentration and antibody test? Not sure on the labs available in your area, most can do this. Here's labcorp for the sake of an example: https://www.labcorp.com/test-menu/18766/adalimumab-concentration-and-anti-adalimumab-antibody--serial-monitor. The test can help tell if you are at ideal therapeutic blood concentration of humira, and whether an anti-humira antibodies are present which would make that medication less effective or no longer work. If less than therapuedic, or low antibodies then increasing your dosage can help. If you have high humira levels then increasing will not help. You'd switch meds if you have high antibodies.

Have you considered adding a thiopurine (azathioprine/imuran/6mp) to your current treatment?

If the inflammation is very mild, have you considered adding back an oral mesalamine (asacol/lialda/pentasa)?